Академический Документы
Профессиональный Документы
Культура Документы
2018
2017 data
HIV/AIDS surveillance in Europe
2018
2017 data
Abstract The designations employed and the presentation of the
HIV transmission remains a major public health concern and material in this publication do not imply the expression of
affects more than 2 million people in the WHO European any opinion whatsoever on the part of the World Health
Region, particularly in the eastern part of the Region. This Organization concerning the legal status of any country,
report is the latest in a series published jointly by European territory, city or area or of its authorities, or concerning the
Centre for Disease Prevention and Control (ECDC) and the delimitation of its frontiers or boundaries. Dotted lines on
WHO Regional Office for Europe that has been reporting maps represent approximate border lines for which there
data on HIV and AIDS in the WHO European Region and in may not yet be full agreement.
the European Union and European Economic Area (EU/EEA)
since 2007. It finds that while epidemic patterns and trends The mention of specific companies or of certain manufac-
vary widely across European countries, nearly 160 000 peo- turers’ products does not imply that they are endorsed or
ple were diagnosed with HIV in the European Region in 2017, recommended by the World Health Organization in prefer-
including 25 000 in the EU/EEA. The increasing trend in new ence to others of a similar nature that are not mentioned.
HIV diagnoses continued for the Region overall, despite Errors and omissions excepted, the names of proprietary
decreasing rates of new diagnoses in the EU/EEA. The report products are distinguished by initial capital letters.
calls for urgent action for countries and areas (especially in
the eastern part) to revamp their political commitment and All reasonable precautions have been taken by the World
scale up efforts to implement the Action plan for the health Health Organization to verify the information contained in
sector response to HIV in the WHO European Region. this publication. However, the published material is being
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EPIDEMIOLOGY Health Organization be liable for damages arising from its
AIDS – PREVENTION AND CONTROL use. The views expressed by authors, editors, or expert
DISEASE OUTBREAKS – STATISTICS groups do not necessarily represent the decisions or the
HIV INFECTIONS – EPIDEMIOLOGY stated policy of the World Health Organization.
POPULATION SURVEILLANCE
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accuracy of the translation of the Russian summary.
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This publication follows WHO terminological practice. The
Publications
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Contents
Acknowledgements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .vi
Abbreviations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .vii
Overview of HIV and AIDS in Europe. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1
This report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
European Union and European Economic Area. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
WHO European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Figures
Fig. A. Rate of new HIV diagnoses per 100 000 population, by year of diagnosis and adjusted for reporting delay, in the EU/EEA and
WHO European Region, 1985–2017 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Fig. B. Cumulative number of new HIV diagnoses in the EU/EEA and other countries of the WHO European Region, 1984–2017 . . . . . . . . . . . . . . . . 2
Fig. C. Proportion of people diagnosed late (CD4 cell count < 350 per mm3) by gender, age and transmission,
WHO European Region, 2017 (n = 36 596) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Fig. D. Linkage to care after HIV diagnosis in the EU/EEA, WHO European Region and West, Centre and East,
2017 (n = 26 147) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Fig. E. Estimated new HIV infections and reported new HIV diagnoses in the EU/EEA and WHO European Region, 2008–2017, and target
for 2020 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Рисунок A. Частота зарегистрированных новых случаев ВИЧ-инфекции на 100 000 населения, с разбивкой по году постановки
диагноза, в ЕС/ЕЭЗ и в Европейском регионе ВОЗ, 1985–2017 гг. – с поправкой на задержки в предоставлении данных . . . . . . . . . . . . . . . . 12
Рисунок B. Совокупное число новых случаев ВИЧ-инфекции в ЕС/ЕЭЗ и других странах Европейского Региона ВОЗ, 1984–2017 гг.. . . . . . 13
Рисунок C. Доля лиц с поздно поставленным диагнозом (число клеток CD4 < 350/мм3) с разбивкой по полу, возрасту и пути
передачи, Европейский регион ВОЗ, 2017 г.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Рисунок D. Впервые выявленные ВИЧ-инфицированные пациенты, начавшие получать медицинскую помощь после постановки
диагноза в ЕС/ЕЭЗ, в Европейском регионе ВОЗ, на Западе, в Центре и на Востоке, 2017 г. (n = 26 147) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
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Рисунок E. Расчетное число новых инфекций и новые диагностированные случаи в ЕС/ЕЭЗ и в Европейском регионе ВОЗ,
2007–2017 гг., и цель на 2020 г.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Fig. 1.1. Male-to-female ratio in new HIV diagnoses, by country, EU/EEA, 2017 (n = 25 210). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Fig. 1.2. Age- and gender-specific rates of new HIV diagnoses per 100 000 population, EU/EEA, 2017 (n = 25 210). . . . . . . . . . . . . . . . . . . . . . . . . . 24
Fig. 1.3. New HIV diagnoses, by age group (in years) and transmission mode, EU/EEA, 2017 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Fig. 1.4. Percentage of new HIV diagnoses, by country and age group, EU/EEA, 2017 (n = 25 255) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Fig. 1.5. Percentage of new HIV diagnoses with known mode of transmission, by transmission route and country,
EU/EEA, 2017 (n = 19 230) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
Fig. 1.6. Percentage of new HIV diagnoses among migrants out of all reported cases with known information on region of origin, by
country of report, EU/EEA, 2017 (n = 21 184) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
Fig. 1.7. Percentage of people diagnosed late (CD4 cell count < 350 per mm3) by demographic, EU/EEA, 2017 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Fig. 1.8. People diagnosed with HIV, AIDS and deaths reported per 100 000 population, EU/EEA, 2008–2017. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
Fig. 1.9a. Age-specific trends in new HIV diagnoses in men, 2008–2017 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
Fig. 1.9b. Age-specific trends in new HIV diagnoses in women, 2008–2017 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Fig. 1.10. Percentage of new diagnoses among people born abroad, by year of diagnosis and region of origin, EU/EEA, 2008–2017. . . . . . . . . . . 29
Fig. 1.11a. HIV diagnoses, by year of diagnosis and transmission mode, adjusted for reporting delay, EU/EEA, 2008–2017. . . . . . . . . . . . . . . . . . . 29
Fig. 1.11b. Percentage of HIV diagnoses, by year of diagnosis and transmission mode, adjusted for reporting delay, EU/EEA, 2008–2017. . . . . . 30
Fig. 1.12. New HIV diagnoses, by year of diagnosis, transmission and migration status, EU/EEA, 2008–2017 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Fig. 1.13. Median CD4 cell count per mm3 at HIV diagnosis, by year of diagnosis and transmission group, EU/EEA, 2008–2017 . . . . . . . . . . . . . . . 31
Fig. 1.14. Percentage of AIDS diagnoses within 90 days of HIV diagnosis, EU/EEA, 2017 (n = 1671). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
Fig. 1.15. AIDS diagnoses, by transmission mode, EU/EEA, 2008–2017 (logarithmic scale) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
Fig. 1.16. Percentage of people diagnosed with AIDS with TB as an AIDS-defining illness, EU/EEA, 2017 (n = 2825) . . . . . . . . . . . . . . . . . . . . . . . . . 33
Fig. 2.1. Age- and gender-specific rates of new HIV diagnoses per 100 000 population, WHO European Region, 2017
(n = 54 828). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
Fig. 2.2. New HIV diagnoses, by CD4 cell count per mm3 at diagnosis and transmission mode, WHO European Region, 2017 (n = 33 840). . . . . . . 39
Fig. 2.3a. New HIV diagnoses per 100 000 population, by year of diagnosis, WHO European Region,a 2008–2017. . . . . . . . . . . . . . . . . . . . . . . . . . . 40
Fig. 2.3b. Rate of new HIV diagnoses, by year of diagnosis, WHO European Region,a 2008–2017 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
Fig. 2.4. New HIV diagnoses, by transmission mode and year of diagnosis, WHO European Region, 2008–2017 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
Fig. 2.5. AIDS diagnoses per 100 000 population, by geographical area and year of diagnosis, WHO European Region, 2008–2017 . . . . . . . . . . . 41
Fig. 2.6. Male-to-female ratio in all new HIV diagnoses and new diagnoses with heterosexual transmission, by country, East, 2017
(n = 26 459; 5751) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Fig. 2.7. New HIV diagnoses, by country and transmission mode, East, 2017 (n = 26 459) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Fig. 2.8. New HIV diagnoses, by age group and transmission mode, East, 2017 (n = 25 286). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
Fig. 2.9. New HIV diagnoses, by CD4 cell count per mm3 at diagnosis and transmission mode, East, 2017 (n = 19 254). . . . . . . . . . . . . . . . . . . . . . . 44
Fig. 2.10. New HIV diagnoses, by transmission mode and year of diagnosis, East, 2008–2017 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
Fig. 2.11. Age-specific trends by gender in new HIV diagnoses with heterosexual transmission, East, 2008–2017 . . . . . . . . . . . . . . . . . . . . . . . . . . 47
Fig. 2.12. AIDS diagnoses, by transmission mode and year of diagnosis, East, 2008–2017 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
Fig. 2.13. Distribution of the three most common AIDS-defining illnesses per transmission mode, East, 2017. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
Fig. 2.14. Male-to-female ratio in new HIV diagnoses, by country, Centre, 2017. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
Fig. 2.15. New HIV diagnoses, by country and transmission mode, Centre, 2017 (n = 6383). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50
Fig. 2.16. New HIV diagnoses, by CD4 cell count per mm3 at diagnosis and transmission mode, Centre, 2017 (n = 1501). . . . . . . . . . . . . . . . . . . . . . 50
Fig. 2.17. New HIV diagnoses, by transmission mode and year of diagnosis, Centre, 2008–2017 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
Fig. 2.18. New AIDS diagnoses, by transmission mode and year of diagnosis, Centre, 2008–2017. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
Fig. 2.19. New HIV diagnoses, by transmission mode and year of diagnosis, West, 2008–2017. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
Fig. 2.20. New AIDS diagnoses, by transmission mode and year of diagnosis, West, 2008–2017. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
Tables
Table A. Characteristics of new HIV diagnoses reported in the WHO European Region, the EU/EEA, and West, Centre and East of the
WHO European Region, 2017. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Таблица A. Характеристики случаев ВИЧ-инфекции, зарегистрированных в Европейском регионе ВОЗ, в ЕС/ЕЭЗ, в западной,
центральной и восточной частях Европейского региона ВОЗ, 2017 г.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Table 1. New HIV diagnoses and rates per 100 000 population, by country and year of diagnosis (2008–2017) and cumulative totals, in
EU/EEA and other countries of the WHO European Region. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
Table 2. HIV diagnoses in males and rates per 100 000 population, by country and year of diagnosis (2008–2017) and cumulative
totals, in EU/EEA and other countries of the WHO European Region. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
Table 3. HIV diagnoses in females and rates per 100 000 population, by country and year of diagnosis (2008–2017) and cumulative
totals, in EU/EEA and other countries of the WHO European Region. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64
Table 4. New HIV diagnoses in men infected through sex between men, by country and year of diagnosis (2008–2017) and cumulative
totals, in EU/EEA and other countries of the WHO European Region. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66
Table 5. New HIV diagnoses in people infected through injecting drug use, by country and year of diagnosis (2008–2017) and
cumulative totals, in EU/EEA and other countries of the WHO European Region. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
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Table 6. New HIV diagnoses in people infected through heterosexual contact, by country and year of diagnosis
(2008–2017) and cumulative totals, in EU/EEA and other countries of the WHO European Region. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
Table 7. New HIV diagnoses in people infected through mother-to-child transmission, by country and year of diagnosis (2008–2017)
and cumulative totals, in EU/EEA and other countries of the WHO European Region. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
Table 8. HIV diagnoses in 2017, by country of report, transmission mode and sex, in EU/EEA and other countries of the WHO European Region.70
Table 9. HIV diagnoses in 2017, by country of report, age and sex, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . 72
Table 10. HIV diagnoses in people infected through heterosexual contact, by country and transmission subcategory, cases diagnosed
in 2017, in EU/EEA and other countries of the WHO European Region. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
Table 11. HIV diagnoses, by country of report and region of origin, cases diagnosed in 2017, in EU/EEA and other countries of the WHO
European Region. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76
Table 12. HIV diagnoses, by geographical area, transmission mode and country or subcontinent of origin, in cases reported in 2017. . . . . . . . . . 78
Table 12a. EU/EEA and non-EU/EEA countries. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78
Table 12b. West, Centre, East of the WHO European Region. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78
Table 13. New HIV diagnoses, by country of report and probable region of infection, in 2017, in EU/EEA and other countries of the WHO
European Region. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80
Table 14. Percentage of new HIV diagnoses (2017) among people > 14 years reported with information about CD4 cell count, by CD4 cell
count level (< 200 and < 350 cells per mm³ blood) and by transmission mode in cases with CD4 < 350, in EU/EEA and other countries of
the WHO European Region. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83
Table 15. AIDS diagnoses and rates per 100 000 population, by country and year of diagnosis (2008–2017) and cumulative totals, in
EU/EEA and other countries of the WHO European Region. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84
Table 16. AIDS diagnoses in males and rates per 100 000 population, by country and year of diagnosis (2008–2017) and cumulative
totals, in EU/EEA and other countries of the WHO European Region. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86
Table 17. AIDS diagnoses in females and rates per 100 000 population, by country and year of diagnosis (2008–2017) and cumulative
totals, in EU/EEA and other countries of the WHO European Region. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88
Table 18. AIDS diagnoses in men infected through sex with men, by country and year of diagnosis (2008–2017) and cumulative totals,
in EU/EEA and other countries of the WHO European Region. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90
Table 19. AIDS diagnoses in people infected through injecting drug use, by country and year of diagnosis (2008–2017) and cumulative
totals, in EU/EEA and other countries of the WHO European Region. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
Table 20. AIDS diagnoses in people infected through heterosexual contact, by country and year of diagnosis
(2008–2017) and cumulative totals, in EU/EEA and other countries of the WHO European Region. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92
Table 21. AIDS diagnoses in people infected through mother-to-child transmission, by country and year of diagnosis (2008–2017) and
cumulative totals, in EU/EEA and other countries of the WHO European Region. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
Table 22. AIDS diagnoses in 2017, by country of report, transmission mode and sex, in EU/EEA and other countries of the WHO
European Region. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94
Table 23. The most common AIDS-indicative diseases diagnosed in 2017, ordered by frequency. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96
Table 24. AIDS-related deaths, by geographic area, country and year of death (2008–2017) and cumulative totals in EU/EEA and other
countries of the WHO European Region. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
Table 25. AIDS-related deaths, by sex, transmission mode and year of death (2008–2017) and cumulative totals. . . . . . . . . . . . . . . . . . . . . . . . . . . 98
Table 25a. EU/EEA and non-EU/EEA countries. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98
Table 25b. West, Centre, East of the WHO European Region. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100
Table 26. Number of HIV tests performed, excluding unlinked anonymous testing and testing of blood donations, by country and year
(2008–2017) and number of tests per 1000 population in 2017, in EU/EEA and other countries of the WHO European Region . . . . . . . . . . . . . . . . 102
Maps
Map 1. New HIV diagnoses per 100 000 population, 2017. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104
Map 2. New HIV diagnoses in men per 100 000 male population, 2017 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105
Map 3. New HIV diagnoses in women per 100 000 female population, 2017. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105
Map 4. New HIV diagnoses in men who have sex with men per 100 000 male population, 2017 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106
Map 5. New HIV diagnoses acquired through injecting drug use per 100 000 population, 2017. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106
Map 6. New HIV diagnoses acquired through heterosexual transmission per 100 000 population, 2017. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107
Map 7. Percentage of adult (>14 years) HIV diagnoses with CD4 <350 cells/mm3 at diagnosis, 2017. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107
Map 8. AIDS diagnoses reported per 100 000 population, 2017 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108
Annexes
Annex 1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115
Annex 2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115
Annex 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116
Annex 4a . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117
Annex 4b . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118
Annex 5. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119
Annex 6. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121
Annex 7. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122
v
Acknowledgements
This report is published jointly by ECDC and the WHO Regional Office for Europe. The Regional Office developed the analysis
and report sections covering the WHO European Region and validated the data of the non-member countries and areas of the
European Union (EU)/European Economic Area (EEA) and ECDC developed the analysis and report sections covering the EU/EEA
and validated the data of the EU/EEA countries.
The data collection, validation, analysis and overall preparation of this report was coordinated by Anastasia Pharris1 and
Annemarie Stengaard.2
Review and production support was provided by Andrew J. Amato-Gauci,1 Mike Catchpole,1 Sara Croxford,3 Masoud Dara,2
Esther Kissling, 4 Vicky Lefevre,1 Antons Mozalevskis,2 Stine Nielsen,5 Teymur Noori,1 Adrian Prodan,1 Chantal Quinten,1
Elena Vovc,2 and Phillip Zucs.1
1. ECDC
2. WHO Regional Office for Europe
3. Public Health England
4. EpiConcept
5. Freelance consultant
ECDC and the WHO Regional Office for Europe would like to thank the nominated operational contact points for HIV/AIDS
surveillance from European Union/European Economic Area (EU/EEA) Member States and areas and the HIV/AIDS surveil-
lance focal points from the non-EU/EEA Member States and areas of the WHO European Region for providing data and
valuable comments on this report:
Albania: Marjeta Dervishi; Andorra: Jennifer Fernández Garcia; Armenia: Trdat Grigoryan; Austria: Daniela Schmid, Ziad
El-Khatib; Azerbaijan: Farhad Singatulov, Shahin Khasiyev; Belarus: Svetlana Sergeenko, Pavel Yurovski; Belgium: Andre
Sasse, Dominique Van Beckhoven; Bosnia and Herzegovina: Serifa Godinjak; Bulgaria: Tonka Varleva; Croatia: Tatjana
Nemeth Blazic; Cyprus: Linos Hadjihannas, Maria Koliou; Czech Republic: Marek Maly; Denmark: Susan Cowan; Estonia:
Kr sti Rüütel; Finland: Kirsi Liitsola, Mika Salminen; France: Françoise Cazein, Josiane Pillonel, Florence Lot; Georgia:
Otar Chokoshvili, Maia Tsereteli; Germany: Barbara Gunsenheimer-Bartmeyer; Greece: Vasilios Raftopoulos, Stavros
Patrinos; Hungary: Maria Dudas; Iceland: Haraldur Briem, Gudrun Sigmundsdottir; Ireland: Derval Igoe, Kate O’Donnell;
Israel: Daniel Chemtob, Yana Roshal; Italy: Barbara Suligoi; Kazakhstan: Lolita Ganina, Gulnar Temirkhanov; Kyrgyzstan:
Aigul Solpueva; Latvia: Šarlote Konova; Liechtenstein: Andrea Leibold, Marina Jamnicki; Lithuania: Irma Čaplinskienė;
Luxembourg: Aurelie Fischer, Jean-Claude Schmit; Malta: Jackie Maistre Melillo, Tanya Melillo; Monaco: Dominique De
Furst; Montenegro: Alma Cicic; Netherlands: Eline Op de Coul, Ard van Sighem; Norway: Hans Blystad; Poland: Magdalena
Rosinska; Portugal: Isabel Aldir, Helena Cortes Martins; Republic of Moldova: Silvia Stratulat, Stepan Gheorghita;
Romania: Mariana Mardarescu; San Marino: Andrea Gualtieri, Mauro Fiorini; Serbia: Danijela Simic; Slovakia: Peter
Truska; Slovenia: Irena Klavs, Tanja Kustec, Maja Milavec; Spain: Asuncion Diaz; Sweden: Maria Axelsson; Switzerland:
Martin Gebhardt; Tajikistan: Kholnazarov Ramshed, Zukhra Nurlaminova; the former Yugoslav Republic of Macedonia:
Milena Stefanovic, Zarko Karadzovski, Vladimir Mikic, Rumena Gerdovska; Turkey: Emel Özdemir Şahin; Ukraine: Ihor
Kuzin, Violetta Martsynovska; and United Kingdom: Valerie Delpech. Also Kosovo:1 Luljeta Gashi.
1 For the purposes of this publication, all references to “Kosovo”, including in the bibliography, should be understood/read as “Kosovo (in accordance
with Security Council resolution 1244 (1999))”.
vi
Abbreviations
vii
SURVEILLANCE REPORT HIV/AIDS surveillance in Europe 2018 – 2017 data
Table A. Characteristics of new HIV diagnoses reported in the WHO European Region, the EU/EEA, and West, Centre and
East of the WHO European Region, 2017
1
HIV/AIDS surveillance in Europe 2018 – 2017 data SURVEILLANCE REPORT
European Region,1 which corresponds to a rate of 20.0 Regional Office for Europe surveillance system, includ-
newly diagnosed infections per 100 000 population ing 25 353 from the EU/EEA, while information about
(Table A). This number includes 55 018 new diagnoses 104 402 new diagnoses in the Russian Federation
reported by 49 countries to the joint ECDC and WHO was published by the Russian Federal Scientific and
Methodological Centre for Prevention and Control of
AIDS (1) (Fig. A). Over the course of the last three dec-
1 No data were available from Germany (no data export for 2017 due
to technical problems), Turkmenistan or Uzbekistan. Liechtenstein ades, over 2.3 million people have been diagnosed and
is an EEA Member but not a WHO Member State, so its data are reported with HIV in the WHO European Region, includ-
included in the totals for the EU/EEA but not for the WHO European
Region. No official data were reported by the Russian Federation, ing over 650 000 people in the EU/EEA (Fig. B).
but citable data were obtained through publicly available sources (1)
and included within the other countries’ reported data for the overall
number, rate and trend of HIV diagnoses in the European Region (see
Carrying on a trend that has persisted over the last dec-
“HIV and AIDS diagnoses in the WHO European Region” (Chapter ade, rates and overall numbers of people diagnosed
2)) and the East of the Region (see “HIV and AIDS diagnoses in the
East” (Chapter 2)). This allows a more complete presentation of the with HIV were highest in the East of the Region (51.1 per
epidemiology of HIV in the WHO European Region. Other regional 100 000 population), lower in the West and the EU/ EEA
figures presented in this report (including those by age and gender)
are based on data from the 49 countries that provided data to the (6.9 and 6.2 per 100 000, respectively) and lowest
joint ECDC/WHO European HIV surveillance system.
Fig. A. Rate of new HIV diagnoses per 100 000 population, by year of diagnosis and adjusted for reporting delay, in the
EU/EEA and WHO European Region, 1985–2017
20
New HIV diagnoses per 100 000 population
Year of diagnosis
Countries 25 27 36 36 39 42 42 42 42 44 43 45 48 48 47 47 49 46 50 52 52 52 52 52 52 52 51 51 50 50 50 51 50
reporting
Fig. B. Cumulative number of new HIV diagnoses in the EU/EEA and other countries of the WHO European Region,
1984–2017
1 500 000
1 000 000
500 000
0
1985 1990 1995 2000 2005 2010 2015
Year of diagnosis
2
SURVEILLANCE REPORT HIV/AIDS surveillance in Europe 2018 – 2017 data
in the Centre2 (3.2 per 100 000) (Table A, Fig. A). The the Centre (53%) and lowest in the West (49%), while
main transmission mode varied by geographical area, 49% were diagnosed late in the EU/EEA (Table A, Fig. C).
illustrating the diversity in the epidemiology of HIV in
Europe. Sexual transmission between men was the most Linkage to care, measured as having a CD4 count per-
common mode in the EU/EEA and heterosexual contact formed and reported, was assessed among the 26 147
and injecting drug use were the main reported transmis- new HIV diagnoses in the Region for whom data on
sion modes in the East of the Region. The rate of new date of diagnosis and date of CD4 count were reported.
diagnoses in the Region was higher among men than Among those who were linked to care, 86% had evidence
women in all age groups, except among people under 15 of linkage within three months of diagnosis. This per-
years. centage was highest in the Centre (96%) and lowest in
the East (82%); in the EU/EEA, it was 92% (Fig. D).
Just over half (53%) of those diagnosed with HIV in 2017
in the European Region were diagnosed at a late stage of In 2017, 14 703 people were diagnosed with AIDS, as
infection (CD4 cell count < 350 cells/mm3 at diagnosis). reported in 47 countries3 of the WHO European Region,
This percentage was highest in the East (57%), lower in and the rate of new diagnoses was 2.3 per 100 000 pop-
ulation (Table A, see also Table 15 in the Tables section).
2 The grouping of countries into the West (23 countries), Centre (15 In the EU/EEA, 3130 people were diagnosed with AIDS
countries) and East (15 countries) of the WHO European Region is
based on epidemiological considerations and follows the division
of countries used in reports published by EuroHIV since 1984: see 3 No data were reported by Belgium, Germany, the Russian Federation,
Annex 1, Figure A1.1 for details. Sweden, Turkmenistan or Uzbekistan.
Fig. C. Proportion of people diagnosed late (CD4 cell count < 350 per mm3) by gender, age and transmission,
WHO European Region, 2017 (n = 36 596)
Total
Men
Gender
Women
15–19
20–24
Age group
25–29
(years)
30–39
40–49
50+
Percentage
Fig. D. Linkage to care after HIV diagnosis in the EU/EEA, WHO European Region and West, Centre and East,
2017 (n = 26 147)
0–4 days
Centre
5–14 days
15–28 days
EU/EEA
0 20 40 60 80 100
Percentage
3
HIV/AIDS surveillance in Europe 2018 – 2017 data SURVEILLANCE REPORT
in 2017, giving a rate of 0.7 per 100 000 population. The The trend in reported HIV diagnoses declined slightly
number of AIDS cases has continued to decline steadily between 2008 and 2017. In the earlier part of this period,
in the West and the EU/EEA during the last decade, and rates were 6.9 per 100 000, decreasing slightly to 6.5
while it has nearly doubled in the East, it has begun to in more recent years, and 6.2 in 2017 (see Table 1, Fig.
stabilize and even declined by a slight 7% between 2012 1.8 and Annexes 1, 5 and 6). While the overall EU/EEA
and 2017 (see Fig. 1.12 and 2.4). trend appears to have declined slightly during the last
decade, contrasting trends are seen at national level.
European Union and European Several countries, including Austria, Belgium, Denmark,
Estonia, the Netherlands, Norway, Spain and the United
Economic Area Kingdom, have reported a decline in rates of new diag-
In 2017, 25 353 people were diagnosed with HIV in 30 nosis in recent years, even after adjusting for reporting
of the 31 countries of the EU/EEA, with a rate of 6.2 per delay. Conversely, since 2008, and taking reporting
100 000 when adjusted for reporting delay (Table 1, delay into account, rates of HIV diagnoses have more
Annex 6). Countries with the highest rates of new HIV than doubled in Bulgaria, Cyprus and Lithuania, and
diagnoses reported in 2017 were Latvia (18.8; 371 cases) have increased by over 50% in the Czech Republic,
and Estonia (16.6; 219 cases), and the lowest rates were Hungary, Malta and Poland (Table 1, Annex 6).
reported by Slovakia (1.3; 70 cases) and Slovenia (1.9; 39
Trends differ by gender and age group. Age-specific
cases). The rate of new HIV diagnoses was higher among
rates have declined since 2008 in all age groups except
men (9.0 per 100 000 population; Table 2) than women
for adults over 50 years, with rates among 25–29-year-
(2.8 per 100 000 population; Table 3). The overall male-
olds and 30–39-year-olds consistently higher than other
to-female ratio was 3.1 (Table A). This ratio was highest
groups throughout the period in both women and men
in Croatia (20.2) and Slovenia (18.5) and was above 1
(Fig. 1.9a, 1.9b).
in all countries in the EU/EEA (Fig. 1.1). The predomi-
nant mode of transmission in these countries was sex Trends by transmission mode show that the number of
between men. new HIV diagnoses among men who have sex with men
(MSM) in the EU/EEA decreased slightly in 2017 compared
Men had higher age-specific rates than women in all
to recent years (Fig. 1.11a). Although reporting delay may
age groups except among young people under 15 years,
contribute to this decline, it appears that the drop may
where age-specific rates were similar (Fig. 1.2). The
be substantial in certain countries, including Belgium,
highest overall age-specific rate of HIV diagnoses was
Greece, the Netherlands, Spain and the United Kingdom.
observed among 25–29-year-olds (14.4 per 100 000
Conversely, increases in new diagnoses among MSM
population), largely because this group has the highest
have been noted in Bulgaria, Cyprus, Ireland, Malta,
age-specific rate for men at 22.2 per 100 000 population,
Poland and Romania in recent years. Cases attributed
while rates for women were highest in the 30–39-year
to MSM born outside of the reporting country increased
age group (6.9 per 100 000 population) (Fig. 1.2).
between 2008 and 2017, declining slightly between 2015
Sex between men remains the predominant mode of and 2017 but not to the same extent as observed in EU/
HIV transmission reported in the EU/EEA, accounting EEA-native MSM (Fig. 1.12).
for 38% (9694) of all new HIV diagnoses in 2017 and
The number of heterosexually acquired cases decreased
half (50%) of diagnoses where the route of transmis-
steadily over the last decade (Fig. 1.11a), with sharper
sion was known (Table 4, Table 8, Fig. 1.5). Among those
declines among women and foreign-born heterosexual
with known route of HIV transmission, sex between men
people than among men and non-foreign-born people
was the most commonly reported and accounted for
(Fig. 1.11a, 1.12). The number of HIV diagnoses reported
more than 60% of new HIV diagnoses in 10 countries
as due to injecting drug use has declined since 2008
(Austria, Croatia, the Czech Republic, Hungary, Ireland,
in both foreign-born and non-foreign-born groups, but
the Netherlands, Poland, Slovakia, Slovenia and Spain)
localized outbreaks were seen in 2011–2012, which
(Fig. 1.5).
affected the EU/EEA trend in this group, and smaller local
Heterosexual contact was the second most common outbreaks were also noted in some countries during the
transmission mode among people newly diagnosed in period (Table 5, Fig. 1.10, Fig. 1.11a). Mother-to-child
2017 (33%, equally divided between men and women). transmission and transmission through nosocomial
Transmission due to injecting drug use accounted for infection or blood transfusion also decreased steadily
4% of HIV diagnoses, but the transmission mode was between 2008 and 2017; these types of transmission
not reported or was reported to be unknown for 24% of now represent less than 1% of new cases diagnosed
new HIV diagnoses (Table A). Forty-one per cent of those (Table 8). The number of cases reported to have an
diagnosed in the EU/EEA in 2017 were migrants, defined unknown mode of transmission increased from 13% in
as originating from outside of the country in which they 2008 to 24% in 2017.
were diagnosed (Fig. 1.6), with 18% originating from
Information on CD4 cell count at the time of HIV diagno-
countries in sub-Saharan Africa, 8% from countries in
sis was provided by 25 countries (Table 14) for 16 858
Latin America and the Caribbean, 6% from other coun-
adults and adolescents diagnosed and reported in those
tries in central and eastern Europe, and 4% from other
countries (71% of the total). As in previous years, nearly
countries in western Europe.
half (49%) of all cases with a CD4 cell count available
4
SURVEILLANCE REPORT HIV/AIDS surveillance in Europe 2018 – 2017 data
were diagnosed several years after being infected, with delay5) and the Centre (3.2 per 100 000 population)
a count below 350 cells per mm3; 28% of cases were con- (Table A).
sidered to have advanced HIV infection (CD4 < 200 cells/
mm3). Rates of newly diagnosed HIV infections for 2017 var-
ied significantly among countries in the WHO European
When analysing CD4 cell count by transmission mode, Region, with the highest rates per 100 000 population
the proportion of people presenting several years after observed in the Russian Federation (71.1) (1), Ukraine6
being infected (CD4 < 350 cells/ mm3) was highest among (37.0), Belarus (26.1) and the Republic of Moldova (20.6),
women (52%), older adults (56% in 40–49-year-olds and the lowest in Bosnia and Herzegovina (0.3), Slovakia
and 63% in those over 50), men and women infected (1.3) and Slovenia (1.9) (Table 1).
by heterosexual sex (63% and 53%, respectively), peo-
ple who acquired HIV through injecting drug use (52%), Among the 49 countries that reported to ECDC/WHO for
and migrants from south and south-east Asia (53%) and 2017 7 (the Russian Federation not included), the overall
sub-Saharan Africa (56%) (Table 14, Fig. 1.7). The lowest rate for men was 11.9 per 100 000 population (Table 2)
proportions of late diagnosis, indicated by CD4 counts and for women 5.1 per 100 000 population (Table 3). The
below 350 cells per mm3 at diagnosis, were observed largest proportion of those newly diagnosed in the 49
among younger age groups (33% of 15–19-year-olds and reporting countries were in the age group 30–39 years
32% of those aged 20–24 years), men who acquired HIV (36%), while 9% were young people aged 15–24 years
through sex with another man (37%) and migrants from and 16% were 50 years or older at diagnosis. The male-
other western European countries (34%). While many to-female ratio was 2.2, lowest in the East (1.6), higher
people are still diagnosed late, several years after being in the West (2.9) and highest in the Centre (5.8). People
infected with HIV, the median CD4 cell count at HIV diag- most commonly were infected through heterosexual
nosis has increased significantly over the past decade, sex (49%), with 11% of these cases originating from
from 330 cells/mm3 (95% confidence interval (CI): 322– countries with generalized HIV epidemics, while 21%
338) in 2007 to 391 cells/mm3 (95% CI: 381–400) in 2017. were infected through sex between men, 13% through
The group with the highest median CD4 cell count at injecting drug use and 0.7% through mother-to-child
diagnosis is MSM, with 452 cells/mm3 in 2017 (Fig. 1.13). transmission. Information about transmission mode
was unknown or missing for 15% of the new diagnoses
For 2017, 3130 diagnoses of AIDS were reported by 28 (Table A).
EU/EEA countries, 4 giving a rate of 0.7 cases per 100 000
population (Table 15). Overall, 89% of these AIDS diag- When combining data from the Russian Federation8
noses were made within 90 days of the HIV diagnosis, within data reported by the other 49 countries, hetero-
indicating that most AIDS cases in the EU/EEA are due sexual transmission accounted for 56% of new diagnoses
to late diagnosis of HIV infection. This pattern holds for with a known mode of HIV transmission, injecting drug
all transmission groups except people who acquired HIV use for 30%, sex between men for 14% and mother-to-
through injecting drug use, where 59% of AIDS diagno- child transmission for 0.6%.
ses occur within 90 days of the HIV diagnosis (Fig. 1.14).
In the East, when combining data from the Russian
Fifteen countries reported tuberculosis (TB) (pulmonary
Federation within data reported by the other 12 coun-
and/or extrapulmonary) as an AIDS-defining illness
tries on people for whom the mode of HIV transmission
in 14% of those newly diagnosed with AIDS in 2017
was known, heterosexual transmission accounted for
(Fig. 1.16). In the EU/EEA, the numbers of AIDS cases and
59% of new diagnoses, transmission through injecting
AIDS-related deaths have declined consistently since
drug use for 37%, sex between men for 3% and mother-
the mid-1990s.
to-child transmission for 0.5%. In the 12 reporting
countries alone, 68% were infected through heterosex-
WHO European Region ual transmission and 24% through injecting drug use,
With 159 420 people newly diagnosed with HIV in the while reported transmission through sex between men
WHO European Region in 2017, corresponding to a rate remained low (4% of cases) (Tables 4–6, Table 8). Sex
of 20.0 per 100 000 population, the annual increase in between men (30%) and heterosexual sex (26%) were
new HIV diagnoses continued – but at a slower pace the main reported transmission modes in the Centre, but
than previously (Fig. A). The increase is mainly driven by 40% of those newly diagnosed lacked this information.
the continuing upward trend in the East and the Centre, Sex between men was the predominant mode of trans-
whereas the rate of new diagnoses is declining in the mission in 12 of the 15 countries in the Centre. In the
West (Fig. 2.3a).
5 See Annex 1 for methods and Annex 6 for results.
Of the 159 420 people diagnosed in 2017, 82% were diag- 6 Without taking into account data from Crimea, Sevastopol city and
parts of the non-government controlled areas of Ukraine; adjusting
nosed in the East (130 861), 14% in the West (22 354) and population denominator data to exclude Crimea and Sevastopol city;
4% in the Centre of the Region (6205) (Table A). The rate and excluding infants born to HIV-positive mothers whose HIV status
is undetermined.
was also highest in the East (51.1 per 100 000 popula-
7 No data were received from Germany, the Russian Federation,
tion), being disproportionately higher than in the West Turkmenistan or Uzbekistan.
(6.9 per 100 000 population, adjusted for reporting 8 Among new diagnoses in the Russian Federation with a known mode
of HIV transmission, injecting drug use and heterosexual sex both
accounted for 49% of the new cases, sex between men for < 2% and
4 These were all EU/EEA countries except Sweden and Belgium. mother-to-child transmission for < 1% (1).
5
HIV/AIDS surveillance in Europe 2018 – 2017 data SURVEILLANCE REPORT
West, sex between men remained the main transmission information about CD4 cell count at the time of HIV
mode (40% of cases) followed by heterosexual transmis- diagnosis was available, just over half (53%) were late
sion (34% of cases, among whom 41% originated from presenters, with CD4 cell counts below 350 cells per
generalized epidemic countries); information was lack- mm3, including 32% with advanced HIV infection (CD4
ing for 23% of new diagnoses. < 200 cells/mm3). The percentage of people newly diag-
nosed who were late presenters (CD4 < 350/mm3) varied
The rate of newly diagnosed HIV infections in the 50 across transmission categories and age groups and was
countries increased by 37% over the past 10 years, from highest for people with reported heterosexual transmis-
14.6 per 100 000 population in 2008 (107 385 cases) sion (58%; 62% for men with heterosexual transmission
to 20.0 per 100 000 population in 2017 (159 420 cases) and 54% for women with heterosexual transmission) and
(Fig. 2.3a). The increase is mainly driven by the continu- injecting drug use (55%), and lowest for men infected
ing upward trend in the East, where the rate increased through sex with men (39%) (Fig. C). The percentage
by 68%, from 30.4 per 100 000 (77 228 cases) to 51.1 per increased with age, ranging from 34% and 32% among
100 000 (130 861 cases). The rate increased by a much people aged 15–19 and 20–24 years at diagnosis,
smaller 18% in the 12 officially reporting countries in the respectively, to 66% among those aged 50 years or older.
East (the Russian Federation not included), from 20.0 in By gender, the percentage of late presenters was simi-
2008 to 23.6 in 2017. In the Centre, the rate increased by lar overall (52% for men and 54% for women) which, for
121%, the largest relative increase among the three geo- men, conceals the difference between MSM (who tend to
graphical areas, from 1.4 to 3.1 per 100 000 population get diagnosed earlier) and heterosexual men (who tend
between 2008 and 2017, while in the West it decreased to get diagnosed later). Additionally, there was variation
by 27%, from 9.4 to 6.9 per 100 000 population over the across the Region, with 57% late presenters in the East,
same period (Fig. 2.3b). 53% in the Centre and 48% in the West.
Analysing the overall regional trend for the 49 countries In 2017, 14 703 people were newly diagnosed with AIDS in
that reported to ECDC and WHO (not including Germany, 47 countries of the WHO European Region,9 correspond-
the Russian Federation, Turkmenistan or Uzbekistan), ing to a rate of 2.3 per 100 000 population. Overall, 78%
the rate for the Region decreased by a slight 5%, from of AIDS cases were diagnosed in the East, where the rate
8.8 in 2008 to 8.4 in 2017. However, when adjusting the per 100 000 was also highest (10.2), 17% in the West
2017 rate for reporting delay, the decline is less evident. (with a rate of 0.7 per 100 000) and 6% in the Centre of
the Region (0.4 per 100 000) (Table 15). Twenty per cent
Consistent data on transmission mode were available
of people diagnosed with AIDS presented with TB as an
from 44 countries for the period 2008–2017 (Fig. 2.4).
AIDS-defining illness, ranging from 15% of cases in the
The overall increase in the East was driven by an upsurge
West and 19% in the Centre to 26% in the East. The rate
in the number of HIV diagnoses with reported sexual
of new AIDS diagnoses remained largely stable between
transmission, which increased by 69% for heterosexual
2008 and 2017. There was, however, great variation
transmission and eight-fold for transmission through
across the Region, with a doubling of the rate in the East
sex between men. The increase was considerably larger
for the decade (from 5.1 to 10.2 per 100 000) but also a
among men with heterosexual transmission (a 107%
slight 7% decrease between 2012 and 2017, a stable rate
increase) than women with heterosexual transmission
of 0.4 per 100 000 in the Centre and a steady decline,
(21% increase). Transmission through injecting drug use,
by 67% overall, in the West, from 2.1 to 0.7 per 100 000
while still substantial, decreased by 36% (Fig. 2.10). In
(Fig. 2.5).
the Centre, new diagnoses in people infected through
sex between men doubled between 2008 and 2017;
this was the predominant mode of transmission in 12 Conclusions
of the 15 countries, while heterosexual transmission HIV transmission remains a major public health con-
increased by 43%. Transmission through injecting drug cern and affects more than 2 million people in the WHO
use has levelled off after an outbreak in Romania dur- European Region, in particular in the eastern part of the
ing 2011–2013, resulting in an overall increase of 43% Region. Nearly 160 000 people were diagnosed with
in comparison with the 2008 level (Fig. 2.17). In the HIV in 2017 at a rate of 20.0 per 100 000 population,
West, heterosexual transmission continued its steady once again the highest rate ever reported for one year.
decline and decreased by 49% over the 10-year period An increasing majority, 82%, were diagnosed in the
overall and an even steeper decline among hetero- East of the Region and 16% in the EU/EEA. Newly diag-
sexual women; injecting drug use-related transmission nosed infections from two countries alone (the Russian
decreased by 57% between 2008 and 2017 and is now Federation and Ukraine) contributed 75% of all cases in
decreasing again after a peak in 2012 caused by an out- the WHO European Region and 92% of cases in the East.
break in Greece. New diagnoses due to sex between men The new surveillance data presented in this report indi-
decreased by 21% in comparison with 2008; not all of cate, on the one hand, that the increasing trend in new
this decline can be explained by reporting delay. New HIV diagnoses continued for the WHO European Region,
diagnoses with unknown transmission mode increased particularly in the eastern and central parts, but at a
by 51% in the West (Fig. 2.19). slower rate for the decade than previously. On the other
Late HIV diagnosis remains a challenge in the Region.
9 No data were available from Belgium, Germany, the Russian
Among people newly diagnosed (> 14 years) for whom Federation, Sweden, Turkmenistan or Uzbekistan.
6
SURVEILLANCE REPORT HIV/AIDS surveillance in Europe 2018 – 2017 data
hand, the data confirm stabilizing and even decreasing everyone living with HIV to be offered ART regardless of
rates in several EU/ EEA countries in more recent years. disease stage.
The current increasing trends indicate that the Region is One in five people living with HIV in the Region are
not on track to meet the WHO and Joint United Nations unaware of their infection (6) (for more details on esti-
Programme on HIV/AIDS (UNAIDS) targets (2–4) outlin- mates, see UNAIDS (7)). New strategies are required to
ing the path to attaining United Nations Sustainable decrease the number of people who are diagnosed late
Development Goal (SDG) 3.3, which calls to “End the or are unaware of their infection, expanding diversified
epidemics of AIDS, tuberculosis, malaria, and neglected and user-friendly approaches to more widely available
tropical diseases and combat hepatitis, water-borne HIV testing. WHO consolidated guidelines on HIV self-
and other communicable diseases” (5). Estimated new testing and partner notification and ECDC guidance on
infections, currently at an historic high, would need to integrated HIV and hepatitis B and C testing recommend
decrease by 78% by 2020 for the Region to achieve the implementation of innovative approaches that include
target. Even in the EU/EEA, where the overall trend has self-testing and testing provided by lay providers as part
declined slightly in recent years, achieving the target of overall HIV testing services (8–10). Policy-monitoring
would require a decline in estimated new infections of in the Region, however, indicates that implementation
74% by 2020 (Fig. E). of community-based testing, self-testing and voluntary
partner notification are limited or non-existent in many
While epidemic patterns and trends vary widely across European countries (11). HIV testing services should
European countries, sustained increases have been focus on reaching the most affected population groups
seen in the number of newly diagnosed infections in in the local epidemic context, be tailored to the spe-
certain transmission groups in parts of the Region: MSM cific needs of these groups and support timely linkage
in the Centre and East, and heterosexual transmission to HIV prevention, treatment and care. This will ensure
in the East. Heterosexual transmission has decreased earlier diagnoses and treatment initiation, and result in
substantially in the EU/EEA and the West, particularly improved treatment outcomes and reduced morbidity,
among women, as has the number of cases due to sex mortality and HIV incidence in support of the 90–90–
between men in selected countries in the EU/EEA and 9010 and other regional and global targets (2–4).
West in recent years. Transmission through injecting
drug use has continued to decrease in many countries, Evidence that early initiation of ART is beneficial both to
although it still accounted for 37% of reported new diag- the health of the person being treated and in prevent-
noses with a known mode of transmission in the East in ing onward HIV transmission is now solidly confirmed
2017. (12–17). Nearly 90% of countries in the WHO European
Region have a policy to provide treatment regardless of
Too many people throughout the WHO European Region CD4 count (6,18).
are diagnosed late (53%), which is increasing their risk of
ill health, death and onward HIV transmission. The high Interventions to control the epidemic should be based
number of AIDS diagnoses in the East confirms that late on evidence and adapted to national and local epide-
HIV diagnosis, delayed initiation of antiretroviral treat- miology. From the comprehensive epidemiological data
ment (ART) and low treatment coverage remain major presented in this report, the following can be concluded.
challenges. At the same time, the stabilizing AIDS trend
observed since 2012 may be the result of the increasing 10 The 90–90–90 targets are that 90% of people living with HIV
majority of countries in the East that have now imple- know their HIV status, 90% of diagnosed people living with HIV
receive treatment, and 90% of people on treatment achieve viral
mented so-called treat-all policies, which aim to support suppression.
Fig. E. Estimated new HIV infections and reported new HIV diagnoses in the EU/EEA and WHO European Region,
2008–2017, and target for 2020
140 000
EU/EEA estimated infections
120 000
2020 target, EU/EEA
100 000
EU/EEA diagnoses
80 000
60 000
40 000
20 000
0
2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
7
HIV/AIDS surveillance in Europe 2018 – 2017 data SURVEILLANCE REPORT
• For the countries in the EU/EEA and West, given the where one partner is engaged in a high-risk behav-
predominance of HIV transmission among MSM and iour (such as injecting drug use) or is spending longer
increases in some countries, it would appear that cur- periods of time abroad. The large number of new diag-
rent prevention and control interventions need to be noses in people infected through injecting drug use
scaled up and strengthened and should remain the emphasizes that evidence-based policies focused on
priority cornerstone of the HIV response. Countries key populations, including high coverage of harm-
with declines have demonstrated the impact of chang- reduction programmes for people who inject drugs,
ing the culture towards more frequent testing for remain critical to the HIV response in the eastern part
at-risk gay men and linkage to immediate care and ART of the Region. Following repeat calls for urgent action,
for those found to be positive (19). Multicomponent most recently by the WHO Regional Director for Europe
interventions and the inclusion of pre-exposure during a ministerial policy dialogue on HIV and related
prophylaxis (PrEP) for HIV, self-testing and assisted comorbidities in eastern Europe and central Asia
voluntary partner notification into the package of (EECA) attended by 11 ministers or deputy ministers of
prevention and control interventions could help to health from 11 EECA countries in July 2018 (28), coun-
curb this increased trend (8,20,21). The 2011–2012 tries in the eastern part of the Region are revamping
increase in HIV cases among people who inject drugs their political commitment and efforts to implement
and continued reported local outbreaks in a number of the action plan for the health sector response to HIV
countries (22–25) demonstrates the need to maintain in the WHO European Region, including through the
or scale up harm-reduction programmes. development of roadmaps for accelerating efforts to
reach the UNAIDS and WHO 2020 targets (2–4).
• For the countries in the Centre, new diagnoses over-
all are increasing faster than in any other part of the To facilitate the sharing of lessons learned in the HIV
WHO European Region. There is a very strong gender response across European countries, national health
disparity in the rate of new HIV diagnoses in this part authorities, national and international experts and civil
of the Region, with alarming increases among men, society organizations involved in the provision of HIV
particularly MSM, compared with a fairly stable rate prevention, testing, treatment and care services were
among women. Sex between men is the predominant solicited to share their examples of good practices in the
mode of transmission in 12 of the 15 Centre countries. health sector response to HIV. This resulted in 52 exam-
Introduction of PrEP for high-risk groups, HIV test- ples from 33 Member States being published in the first
ing by lay providers, HIV rapid diagnostic tests, HIV compendium of good practices from the WHO European
self-testing and voluntary assisted partner notifica- Region (29).
tion alongside policies and practices to offer ART to
all people living with HIV are needed. Some countries Robust surveillance data are critical for monitoring and
went through a transition to domestic financing of the informing the public health response to the European
HIV response after withdrawal of funding from the HIV epidemic in an accurate and timely fashion. The
Global Fund. This has posed sustainability challenges, number of countries conducting enhanced HIV surveil-
particularly in relation to financing of HIV prevention lance and reporting surveillance data at European level
programmes. Increased political will and attention, has gradually increased over time. In 2017, 41 countries
alongside intensified involvement of civil society, is submitted linked HIV and AIDS data, enabling greater
needed to mitigate some of these challenges and pre- understanding of the clinical status of people diag-
vent the epidemic from accelerating (26). nosed with HIV. This approach increases possibilities
for longer-term monitoring of HIV continuum-of-care out-
• For the countries in the East, there is an urgent need to
comes, such as modelling of the undiagnosed fraction,
continue the scale up of bold, evidence-based interven-
and measurement of linkage to care, treatment and viral
tions and deliver more effective, integrated services
suppression following diagnosis. It can also support
through health systems that better address the social
national and global efforts to monitor progress towards
determinants of health. Comprehensive combination-
the 90–90–90 and other global and regional targets.
prevention and innovative HIV-testing strategies are
needed, with a particular focus on reaching key popu-
References11
lations. This can be achieved through user-friendly 1. Information note ‘Spravka’ on HIV infection in the Russian
prevention and testing services, including assisted Federation as of 31 December 2017. Moscow: Russian Federal
Scientific and Methodological Centre for Prevention and Control of
partner notification, PrEP, HIV testing performed by AIDS; 2018.
trained lay providers and self-testing in line with WHO 2. Global health sector strategy on HIV, 2016–2021 – towards ending
recommendations; these should be integrated into AIDS. Geneva: World Health Organization; 2016 (http://www.who.
int/hiv/strategy2016-2021/ghss-hiv/en/).
national policies and programmes and implemented 3. Ambitious treatment targets: writing the final chap-
(4,8,9,27). Community involvement in the design and ter of the AIDS epidemic. Geneva: UNAIDS; 2014 (http://
w w w. u n a i d s . o r g /s i t e s/d e f a u l t /f i l e s/m e d i a _ a s s e t /
delivery of services is essential to reduce the rate of JC2670_UNAIDS_Treatment_Targets_en.pdf).
new HIV infections and increase the number of peo- 4. Action plan for the health sector response to HIV in the WHO
ple linked to care and initiated and retained on ART, European Region. Copenhagen: WHO Regional Office for Europe;
2017 (http://www.euro.who.int/en/health-topics/communicable-
with the ultimate aim of reducing the high number of diseases/hivaids/publications/2017/action-plan-for-the-health-
sector-response-to-hiv-in-the-who-european-region-2017).
AIDS diagnoses and AIDS-related deaths. Innovative
HIV prevention interventions should address the risk
11 All weblinks in this overview and subsequent chapters were accessed
of heterosexual transmission, particularly in couples on 12 November 2018.
8
SURVEILLANCE REPORT HIV/AIDS surveillance in Europe 2018 – 2017 data
5. United Nations Sustainable Development Goals. About the 19. Brown AE, Mohammed H, Ogaz D, Kirwan PD, Yung M, Nash SG.
Sustainable Development Goals. In: United Nations [website]. Fall in new HIV diagnoses among men who have sex with men
New York (NY): United Nations; 2018 (https://www.un.org/ (MSM) at selected London sexual health clinics since early 2015:
sustainabledevelopment/sustainable-development-goals/). testing or treatment or pre-exposure prophylaxis (PrEP)? Euro
6. Monitoring implementation of the Dublin Declaration on Partnership Surveill. 2017;22(25):pii=30553 (https://doi.org/10.2807/1560-
to fight HIV/AIDS in Europe and Central Asia: thematic report on the 7917.ES.2017.22.25.30553).
HIV continuum of care: Stockholm: ECDC; in press. 20. HIV and STI prevention among men who have sex with men. ECDC
7. Annex on methods. In: Miles to go. Global AIDS update 2018. guidance. Stockholm: ECDC; 2014 (http://ecdc.europa.eu/en/pub-
Geneva: UNAIDS; 2018:255–64 (http://www.unaids.org/sites/ lications/Publications/hiv-sti-prevention-among-men-who-have-
default/files/media_asset/miles-to-go_en.pdf). sex-with-men-guidance.pdf).
8. Guidelines on HIV self-testing and partner notification. Supplement 21. McCormack S, Dunn DT, Desai M, Dolling DI, Gafos M, Gilson R et al.
to consolidated guidelines on HIV testing services. Geneva: Pre-exposure prophylaxis to prevent the acquisition of HIV-1 infec-
World Health Organization; 2017 (http://www.who.int/hiv/pub/ tion (PROUD): effectiveness results from the pilot phase of a prag-
self-testing/hiv-self-testing-guidelines/en/). matic open-label randomised trial. Lancet 2017;378:53–60.
9. Consolidated guidelines on HIV testing services. Geneva: 22. Hedrich D, Kalamara E, Sfetcu O, Pharris A, Noor A, Wiessing
World Health Organization; 2016 (http://www.who.int/hiv/pub/ L et al. Human immunodeficiency virus among people who
guidelines/hiv-testing-services/en/). inject drugs: is risk increasing in Europe? Euro Surveill.
2013;18(48):pii=20648. (http://www.eurosurveillance.org/
10. Public health guidance on HIV, hepatitis B and C testing in the ViewArticle.aspx?ArticleId=20648).
EU/EEA. Stockholm: ECDC; 2018 (https://ecdc.europa.eu/sites/por-
tal/files/documents/HIV-hepatitis-B-and-C-testing-public-health- 23. Giese C, Igoe D, Gibbons Z, Hurley C, Stokes S, McNamara S et
guidance.pdf). al. Injection of new psychoactive substance snow blow asso-
ciated with recently acquired HIV infections among homeless
11. HIV testing. Monitoring implementation of the Dublin Declaration on people who inject drugs in Dublin, Ireland, 2016. Euro Surveill.
Partnership to fight HIV/AIDS in Europe and Central Asia: 2017 pro- 2016;20(40):pii=30036. doi:http://dx.doi.org/10.2807/1560-7917.
gress report. Stockholm: ECDC; 2017 (https://ecdc.europa.eu/sites/ ES.2016.20.40.30036.
portal/files/documents/HIV%20testing.pdf).
24. Public Health England, Health Protection Scotland, Public Health
12. Consolidated guidelines on the use of antiretroviral drugs Wales, Public Health Agency Northern Ireland. Shooting up: infec-
for treating and preventing HIV infection. Recommendations tions among people who inject drugs in the UK, 2016. London:
for a public health approach. Second edition. Geneva: World Public Health England; 2017 (https://www.gov.uk/government/
Health Organization; 2016 (http://apps.who.int/iris/bitstr uploads/system/uploads/attachment_data/file/567231/Shooting_
eam/10665/208825/1/9789241549684_eng.pdf?ua=1). Up_2017_Update.pdf).
13. Guidelines on when to start antiretroviral therapy and 25. HIV in people who inject drugs – joint technical mission to
on pre-exposure prophylaxis for HIV. Geneva: World Luxembourg. Stockholm, Lisbon: ECDC/European Monitoring Centre
Health Organization; 2016 (http://apps.who.int/iris/bitstr for Drugs and Drug Addiction; 2018 (http://sante.public.lu/fr/
eam/10665/186275/1/9789241509565_eng.pdf). publications/h/hiv-joint-technical-mission/index.html).
14. INSIGHT START Study Group. Initiation of antiretroviral 26. Lost in transition. Three case studies of Global Fund withdrawal in
therapy in early asymptomatic HIV infection. N Engl J Med. south eastern Europe. New York (NY): Open Society Foundations;
2016;373(9):795–807. 2017 (https://www.opensocietyfoundations.org/publications/
15. Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC, lost-transition).
Kumarasamy N et al. Prevention of HIV-1 infection with early antiret- 27. Consolidated guidelines on HIV prevention, diagnosis, treatment
roviral therapy. N Engl J Med. 2011;365(6):493–505. and care for key populations. 2016 update. Geneva: World Health
16. Guidelines version 9.0. October 2017. Brussels: European Organization; 2016 (https://www.who.int/hiv/pub/guidelines/
AIDS Clinical Society; 2017 (http://www.eacsociety.org/files/ keypopulations-2016/en/)).
guidelines_9.0-english.pdf). 28. Ministerial policy dialogue on HIV and related comorbidities in east-
17. Rodger A, Cambiano V, Bruun T, Vernazza P, Collins S, Corbelli CM ern Europe and central Asia. In: WHO Regional Office for Europe [web-
et al. Risk of HIV transmission through condomless sex in gay cou- site]. Copenhagen: WHO Regional Office for Europe; 2018 (http://
ples with suppressive ART: the PARTNER2 study expanded results w w w.euro.who.int/en/media-centre/events/events/2018/07/
in gay men. In: AIDS 2018. 22nd International AIDS Conference, ministerial-policy-dialogue-on-hiv-and-related-comorbidities-in-
Amsterdam, the Netherlands, 23–27 July 2018 [website]. Geneva: eastern-europe-and-central-asia).
International AIDS Society; 2018 (Abstract WEAX0104LB, 2018; 29. Compendium of good practices in the health sector response to HIV
https://programme.aids2018.org/Abstract/Abstract/13470). in the WHO European Region. Copenhagen: WHO Regional Office for
18. 2017 global AIDS monitoring (GAM). In: AIDSinfo [website]. Geneva: Europe; 2018 (http://www.euro.who.int/en/publications/abstracts/
UNAIDS; 2017 (www.AIDSinfoonline.org). compendium-of-good-practices-in-the-health-sector-response-to-
hiv-in-the-who-european-region).
9
SURVEILLANCE REPORT HIV/AIDS surveillance in Europe 2018 – 2017 data
Рисунок A. Частота зарегистрированных новых случаев ВИЧ-инфекции на 100 000 населения, с разбивкой по
году постановки диагноза, в ЕС/ЕЭЗ и в Европейском регионе ВОЗ, 1985–2017 гг. – с поправкой на задержки в
предоставлении данных
20
Европейский регион ВОЗ
18
Число случаев на 100 000 населения
ЕС/ЕЭЗ
16
14
12
10
8
6
4
2
0
1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 2014 2016
Страны,
предоста- Год постановки диагноза
вившие
данные 25 27 36 36 39 42 42 42 42 44 43 45 48 48 47 47 49 46 50 52 52 52 52 52 52 52 51 51 50 50 50 51 50
В ближайшие годы эти показатели могут увеличиться из-за задержек в предоставлении данных.
Примечание: показатели заболеваемости для ЕС/ЕЭЗ и Европейского региона ВОЗ включают данные по всем странам, предоставившим отчетность
за анализируемый год, включая Российскую Федерацию (1), а также расчетные показатели по Германии за 2017 г. Поэтому показатели за 2017 г.,
представленные здесь, немного ниже, чем показатели, приведенные в других разделах доклада.
12
SURVEILLANCE REPORT HIV/AIDS surveillance in Europe 2018 – 2017 data
Рисунок B. Совокупное число новых случаев ВИЧ-инфекции в ЕС/ЕЭЗ и других странах Европейского Региона
ВОЗ, 1984–2017 гг.
Другие страны
2 000 000 Европейского региона ВОЗ
случаев ВИЧ-инфекции
1 500 000
1 000 000
500 000
0
1985 1990 1995 2000 2005 2010 2015
Год постановки диагноза
Рисунок C. Доля лиц с поздно поставленным диагнозом (число клеток CD4 < 350/мм3) с разбивкой по полу,
возрасту и пути передачи, Европейский регион ВОЗ, 2017 г.
Всего
Мужчины
Пол
Женщины
15–19
20–24
Возраст
25–29
30–39
40–49
50+
Путь передачи
Процентная доля
13
HIV/AIDS surveillance in Europe 2018 – 2017 data SURVEILLANCE REPORT
Рисунок D. Впервые выявленные ВИЧ-инфицированные пациенты, начавшие получать медицинскую помощь после
постановки диагноза в ЕС/ЕЭЗ, в Европейском регионе ВОЗ, на Западе, в Центре и на Востоке, 2017 г. (n = 26 147)
0–4 дней
Центр
5–14 дней
15–28 дней
ЕС/ЕЭЗ
0 20 40 60 80 100
Процентная доля
14
SURVEILLANCE REPORT HIV/AIDS surveillance in Europe 2018 – 2017 data
последние годы, даже с поправкой на задержку отчет- От 25 стран была получена информация о количе-
ности. С другой стороны, с 2008 г. с учетом задержки стве лимфоцитов CD4 на момент постановки диа-
отчетности показатели диагностированных случаев гноза ВИЧ-инфекции (таблица 14) у 18 282 взрослых
ВИЧ-инфекции более чем удвоились в Болгарии, на и подростков (71% от общего количества впервые
Кипре и в Литве и увеличились более чем на 50% в диагностированных случаев ВИЧ-инфекции). Как и
Венгрии, Мальте, Польше и Чешской Республике в предыдущие годы, почти половина (49%) всех слу-
(таблица 1, приложение 6). чаев с известным количеством лимфоцитов CD4 была
диагностирована через несколько лет после инфици-
Тенденции различаются по половому признаку и по рования, когда число лимфоцитов CD4 было менее
возрастным группам. За период с 2008 г. повозраст- 350 клеток/мм3; при этом у 28% пациентов
ные показатели снизились во всех возрастных груп- наблюдалась продвинутая стадия ВИЧ-инфекции
пах, за исключением людей старше 50 лет. При этом (CD4 < 200 клеток/мм3).
среди 25–29-летних и 30–39-летних показатели были
последовательно выше, чем в других группах на про- При анализе количества лимфоцитов CD4 в зависи-
тяжении всего периода как у женщин, так и мужчин мости от пути передачи ВИЧ процент людей, которым
(рис. 1.9a и 1.9b). диагноз был поставлен через несколько лет после
инфицирования (CD4 < 350 клеток/мм3), был самым
Анализ динамики заболеваемости ВИЧ-инфекцией в высоким среди женщин (52%), людей среднего и
разбивке по путям передачи показывает, что число пожилого возраста (56% в возрасте 40–49 лет и 63%
впервые диагностированных случаев ВИЧ-инфекции в возрасте старше 50 лет), мужчин и женщин, инфици-
среди мужчин, имеющих половые контакты с мужчи- рованных при гетеросексуальных половых контактах
нами (МСМ), в ЕС/ЕЭЗ в 2017 г. несколько сократилось (63% и 53% соответственно), людей, которые были
по сравнению с предыдущими годами (рис. 1.11a). инфицированы ВИЧ при употреблении инъекцион-
Хотя задержка отчетности может частично объяснить ных наркотиков (52%), а также мигрантов из Южной
такое снижение, это снижение, по-видимому, может и Юго-Восточной Азии (53%) и из стран Африки к
быть весьма выраженным в некоторых странах, югу от Сахары (56%) (табл. 14, рис. 1.7). Самый низ-
включая Бельгию, Грецию, Испанию, Нидерланды и кий процент случаев поздней диагностики, о которой
Соединенное Королевство. И наоборот, в таких стра- свидетельствовал уровень лимфоцитов CD4 менее
нах, как Болгария, Ирландия, Кипр, Мальта, Польша 350 клеток/мм3 на момент постановки диагноза, был
и Румыния в последние годы имело место увели- зарегистрирован в более молодых возрастных груп-
чение числа новых диагнозов ВИЧ-инфекции среди пах (15–19 лет – 33%, 20–24 года – 32%), среди муж-
МСМ. Число случаев ВИЧ-инфицирования среди чин, которые заразились при половых контактах с
МСМ, родившихся за пределами страны, предостав- мужчинами (37%), и среди мигрантов из других стран
ляющей данные, увеличилось в период с 2008 по Западной Европы (34%). Хотя у многих людей диагноз
2017 г., незначительно снизившись в период с 2015 по ВИЧ-инфекции все еще ставится на поздней стадии,
2017 г., но не в такой степени, которая наблюдалось то есть через несколько лет после заражения ВИЧ,
среди МСМ в странах ЕС/ЕЭЗ (рис. 1.12). медианное количество лимфоцитов CD4 на момент
постановки диагноза значительно увеличилось за
В течение последнего десятилетия число случаев
последнее десятилетие – с 330 клеток/мм3 (95%
гетеросексуальной передачи последовательно сни-
доверительный интервал (ДИ): 322–338) в 2007 г. до
жалось (рис. 1.11а), причем более выражено это
391 клеток/мм3 (95% ДИ: 381–400) в 2017 г. Группа
происходило среди женщин и гетеросексуалов ино-
с наибольшим медианным количеством лимфоци-
странного происхождения, чем среди мужчин и лиц
тов CD4 на момент постановки диагноза – это МСМ,
коренного населения (рис. 1.11a, 1.12). Число диа-
среди которых этот показатель в 2017 г. был равен
гностированных случаев ВИЧ-инфекции, связан-
452 клеткам/мм3 (рис. 1.13).
ных с употреблением инъекционных наркотиков,
снизилось с 2008 г. как среди лиц иностранного В 2017 г. в 28 странах ЕС/ЕЭЗ было диагностировано
происхождения, так и среди лиц коренного насе- и зарегистрировано 3130 случаев СПИДа 4, что соста-
ления – за исключением локальных вспышек в вило 0,7 случая на 100 000 населения (таблица 15).
2011–2012 гг., повлиявших на тенденцию пока- В целом, 89% этих диагнозов были сделаны в тече-
зателей ЕС/ЕЭЗ в этой группе, и менее широких ние 90 дней с момента постановки диагноза ВИЧ-
локальных вспышек, отмеченных в этот период в инфекции, свидетельствуя о том, что большинство
некоторых странах (табл. 5, рис. 1.10, рис. 1.11a). случаев СПИДа в ЕС/ЕЭЗ – это результат поздней диа-
Показатели передачи ВИЧ от матери ребенку, гностики ВИЧ-инфекции. Эта закономерность харак-
внутрибольничного инфицирования и инфици- терна для всех групп пациентов, сформированных
рования при переливании крови также после- в зависимости от пути заражения ВИЧ-инфекцией,
довательно снижались в период между 2008 и за исключением людей, зараженных при употребле-
2017 гг., и теперь они составляют менее 1% новых нии инъекционных наркотиков, у которых в течение
диагностированных случаев ВИЧ-инфекции 90 дней с момента выявления ВИЧ-инфекции диагноз
(таблица 8). Частота случаев с неизвестным путем СПИДа ставится 59% пациентов (рис. 1.14). В 2017 г.
заражения увеличилась с 13% в 2008 г. до 24% в
2017 г. 4 Все они были странами ЕС/ЕЭЗ, за исключением Швеции и
Бельгии.
15
HIV/AIDS surveillance in Europe 2018 – 2017 data SURVEILLANCE REPORT
14 стран сообщили о выявлении туберкулеза (легоч- центральной части Региона (5,8). Распределение
ного и/или внелегочного) как СПИД-индикаторного случаев ВИЧ-инфекции по путям передачи является
заболевания в 14% новых случаев СПИДа (рис. 1.16). следующим: гетеросексуальные контакты – 49%, в
С середины 1990-х гг. в странах ЕС/ЕЭЗ наблюдается том числе 11% у выходцев из стран с генерализован-
последовательное снижение числа новых случаев ной эпидемией ВИЧ-инфекции; половые контакты
СПИДа и случаев смерти от СПИДа. между мужчинами – 21%; употребление инъекци-
онных наркотиков – 13%; передача ВИЧ от матери
Европейский регион ВОЗ ребенку – 0,7%. По 15% новых случаев ВИЧ-инфекции
информация о пути передачи вируса неизвестна или
В 2017 г. в Европейском регионе ВОЗ было зареги- отсутствует (Таблица А).
стрировано 159 420 новых случаев ВИЧ-инфекции
(20,0 на 100 000 населения). Таким образом ежегод- После того, как данные по Российской Федерации8
ный рост количества новых диагнозов ВИЧ-инфекции были объединены с данными, предоставленными дру-
продолжался, но более медленными темпами, чем гими 49 странами, среди людей с известным путем
прежде (рис. А). Этот рост обусловлен главным обра- заражения распределение случаев было следующим:
зом продолжающейся тенденцией к повышению забо- гетеросексуальные контакты – 56%, употребление
леваемости ВИЧ-инфекцией на Востоке и в Центре, в инъекционных наркотиков – 30%, половые кон-
то время как на Западе Региона частота новых слу- такты между мужчинами – 14%, передача от матери
чаев ВИЧ-инфекции снижается (рис. 2.3a). ребенку – 0,6%.
Из 159 420 случаев ВИЧ-инфекции, впервые диа- На Востоке Региона (после того, как данные по
гностированных в 2017 г., 82% были выявлены на Российской Федерации были объединены с данными,
Востоке (130 861), 14% на Западе (22 354) и 4% в предоставленными 12 другими странами) среди
Центре Региона (6205) (таблица А). В восточной части людей с известным путем передачи ВИЧ распреде-
Региона также были зарегистрированы самые высо- ление случаев было следующим: гетеросексуальные
кие показатели заболеваемости ВИЧ-инфекцией (51,1 контакты – 59%, употребление инъекционных нарко-
на 100 000 населения), что значительно выше, чем тиков – 37%, половые контакты между мужчинами
на Западе (6,9 на 100 000, с поправкой на задержку – 3%, передача от матери ребенку – 0,5%. В 12 предо-
отчетности5) и в Центре Региона (3,2 на 100 000) ставивших данные государствах 68% ВИЧ-позитивных
(таблица А). людей заразились при гетеросексуальных контактах,
24% – при употреблении инъекционных наркотиков
Показатели новых диагностированных случаев ВИЧ- и 4% – при половых контактах между мужчинами
инфекции в 2017 г. существенно различались между (таблицы 4–6, таблица 8). Основными путями пере-
странами Европейского региона ВОЗ. Самые высо- дачи ВИЧ-инфекции в центральной части Региона
кие показатели на 100 000 населения наблюдались были половые контакты между мужчинами (30%) и
в Российской Федерации (71,1) (1), Украине6 (37,0), гетеросексуальные контакты (26%). У 40% пациен-
Беларуси (26,1) и Республике Молдова (20,6), а самые тов с впервые диагностированной ВИЧ-инфекцией
низкие – в Боснии и Герцеговине (0,3), Словакии (1,3) информация о пути заражения отсутствовала.
и Словении (1,9) (Таблица 1). Половые контакты между мужчинами были преоб-
ладающим путем передачи ВИЧ-инфекции в 12 из
Для 49 стран, предоставивших данные в ECDC/ВОЗ за 15 стран центральной части Региона. В западной
2017 г.7 (Российская Федерация не включена), общий части Региона половые контакты между мужчинами
показатель заболеваемости для мужчин составил остаются основным путем передачи ВИЧ-инфекции
11,9 (таблица 2), а для женщин – 5,1 на 100 000 насе- (40% случаев), за которым следуют гетеросексуаль-
ления (таблица 3). Наибольшая доля лиц с впервые ные контакты (34%, среди которых 41% приходился
диагностированной ВИЧ-инфекцией в 49 странах, на выходцев из стран с генерализованной эпидемией
предоставивших данные, приходится на возрастную ВИЧ-инфекции). Для 23% пациентов с впервые диа-
группу 30–39 лет (36%), 9% – на молодежь в возрасте гностированной ВИЧ-инфекцией информация о пути
15–24 года и 16% – на людей в возрасте 50 лет и старше заражения отсутствовала.
на момент постановки диагноза. Соотношение слу-
чаев ВИЧ-инфекции у мужчин и женщин было равно За последние десять лет в 50 странах показатели
2,2 – с самым низким значением в восточной части впервые диагностированных случаев ВИЧ-инфекции
Региона (1,6), более высоким значением в западной увеличились на 37% (с 14,6 на 100 000 населения в
части Региона (2,9) и самым высоким значением в 2008 г. (107 385 случаев), до 20,0 на 100 000 населе-
ния в 2017 г. (159 420 случаев) (рис. 2.3а). Увеличение
происходило, главным образом, за счет сохра-
5 Более подробная информация приведена в приложении 1 и
приложении 6. нения восходящей тенденции в восточной части
6 Без учета данных по Крыму, городу Севастополю и ряду Региона, где этот показатель увеличился на 68% – с
территорий Украины, не контролируемых государством; с
корректировкой знаменателя (численность населения), чтобы
исключить Крым и город Севастополь; и за исключением детей,
рожденных ВИЧ-инфицированными матерями, чей ВИЧ-статус 8 В Российской Федерации новые случаи ВИЧ-инфекции с
еще не определен. известным путем заражения распределялись следующим
образом: употребление инъекционных наркотиков и
7 Никаких данных от Германии, Российской Федерации, гетеросексуальные контакты – 49%, половые контакты между
Туркменистана и Узбекистана получено не было. мужчинами – 1,5% и передача от матери ребенку – 0,8% (1).
16
SURVEILLANCE REPORT HIV/AIDS surveillance in Europe 2018 – 2017 data
30,4 на 100 000 (77 228 случаев) до 51,1 на 100 000 (старше 14 лет) с имеющейся информацией о коли-
(130 861 случай). В 12 странах восточной части честве лимфоцитов CD4 на момент постановки диа-
Региона (Российская Федерация не входит в их гноза, у чуть более половины (53%) диагноз был
число), официально предоставляющих отчетность, поставлен поздно; число лимфоцитов CD4 было
этот показатель увеличился гораздо меньше (на 18%) менее 350 клеток/мм3, включая 32% пациентов с про-
– с 20,0 в 2008 г. до 23,6 в 2017 г. В период с 2006 по двинутой стадией ВИЧ-инфекции (CD4 < 200 клеток/
2015 г. в центральной части Региона этот показатель мм3). Процентная доля людей с впервые выявленной
увеличился на 121% (наибольшее относительное уве- ВИЧ-инфекцией на поздней стадии (CD4 < 350/мм3)
личение среди всех трех географических зон) – от 1,4 варьировалась в зависимости от пути передачи и
до 3,1 на 100 000 населения, в то время как в запад- возрастной группы, и была самой высокой у инфици-
ной части Региона он снизился на 27% – от 9,4 до 6,9 рованных при гетеросексуальных половых контактах
на 100 000 населения (рис. 2.3b). (58%; 62% для мужчин и 54% для женщин) и при упо-
треблении инъекционных наркотиков (55%) и самой
Анализ общей региональной тенденции для 49 стран, низкой у мужчин, инфицированных при половых кон-
предоставивших отчеты в ECDC и ВОЗ (не включая тактах с мужчинами (39%) (рис. C). Эта доля повыша-
Германию, Российскую Федерацию, Туркменистан и ется с увеличением возраста на момент постановки
Узбекистан), показывает, что показатель для всего диагноза: от 34% и 32% у людей в возрасте 15–19 и
региона снизился на 5% с 8,8 в 2008 г. до 8,4 в 2017 г. 20–24 лет до 66% у людей в возрасте 50 лет и старше.
Каких-либо значительных различий в частоте случаев
За период 2007–2017 гг. соответствующие данные
поздней диагностики у мужчин и женщин выявлено
о пути передачи инфекции поступили из 44 стран
не было (соответственно 52% и 54%). Однако общий
(рис. 2.4). На Востоке общий рост был обусловлен
показатель для мужчин не позволяет увидеть разли-
быстрым увеличением числа диагностированных
чие в частоте случаев поздней диагностики у МСМ (у
случаев передачи ВИЧ-инфекции половым путем – на
которых, как правило, диагноз ставится раньше) и у
69% для гетеросексуальной передачи и в восемь раз
гетеросексуальных мужчин (у которых, это, как пра-
для передачи при половых контактах между мужчи-
вило, происходит позже). Показатели поздней диа-
нами. Этот рост был значительно выше среди мужчин,
гностики различались и в рамках Региона – 57% на
зараженных при гетеросексуальных контактах (уве-
Востоке, 53% в Центре и 48% на Западе.
личение на 107%), чем среди женщин, зараженных
таким же путем (увеличение на 21%). Частота случаев В 2017 г. в 47 государствах-членах Европейского
передачи инфекции при употреблении инъекцион- региона ВОЗ9 было зарегистрировано 14 703 новых
ных наркотиков снизилась на 36%, хотя она про- случая СПИДа, и заболеваемость СПИДом, таким
должает оставаться на достаточно высоком уровне образом, составила 2,3 случая на 100 000 населе-
(рис. 2.10). В Центре в период с 2008 по 2017 г. число ния. В целом 78% случаев СПИДа были диагностиро-
впервые выявленных ВИЧ-позитивных лиц, инфици- ваны на Востоке, где показатель на 100 000 человек
рованных при половых контактах между мужчинами, также был самым высоким (10,2), 17% на Западе (0,7
увеличилось почти втрое, и этот путь заражения пре- на 100 000) и 6% в Центре Региона (0,4 на 100 000)
обладает в 11 из 15 стран; в то же время число слу- (таблица 15). Туберкулез был СПИД-индикаторным
чаев передачи ВИЧ-инфекции при гетеросексуальных заболеванием у 20% людей с диагнозом СПИДа. В
контактах увеличилась на 43%. Уровень передачи рамках Региона этот показатель варьировался сле-
ВИЧ при употреблении инъекционных наркотиков дующим образом: 15% на Западе, 19% в Центре и
стабилизировался после вспышки, наблюдавшейся 26% на Востоке. В период с 2008 по 2017 г. частота
в Румынии в 2011–2013 гг., и повысился в целом на новых диагнозов СПИДа оставалась в основном ста-
43% по сравнению с уровнем 2008 г. (рис. 2.17). На бильной. Однако в этот же период времени были
Западе частота передачи ВИЧ при гетеросексуальных отмечены очень большие различия в показателях в
контактах продолжала последовательно снижаться и рамках Региона: их увеличение на 100% на Востоке
за 10-летний период в целом уменьшилась на 49% с (от 5,1 до 10,2 на 100 000) с небольшим снижением в
еще более выраженным снижением среди гетеросек- период с 2012 по 2017 г., их стабилизация в Центре (0,4 на
суальных женщин. В период с 2008 по 2017 г. частота 100 000) и их устойчивое снижение на Западе
заражения ВИЧ при употреблении инъекционных (от 2,1 до 0,7 на 100 000) (рис. 2.5).
наркотиков снизилась на 57% и после пика в 2012 г.,
вызванного вспышкой в Греции, в настоящее время
опять снижается. Число впервые диагностированных Выводы
случаев передачи инфекции при половых контактах Эпидемия ВИЧ-инфекции, которая затрагивает более
между мужчинами снизилось на 21% по сравнению 2 миллионов человек в Европейском регионе ВОЗ,
с 2008 г. Это снижение не всегда можно объяснить особенно в восточной его части, остается одной из
задержкой отчетности. Число новых диагнозов ВИЧ- важнейших нерешенных проблем здравоохранения.
инфекции с неизвестным путем передачи увеличи- В 2017 г. ВИЧ-инфекция была диагностирована почти
лось на Западе на 51% (рис. 2.19). у 160 000 человек или у 20,0 человек на 100 000 насе-
ления, продолжая сохраняться на самом высоким
Поздняя диагностика ВИЧ-инфекции остается в
Регионе проблемой, требующей неотложного реше-
ния. Среди впервые выявленных инфицированных 9 Отсутствуют данные по Бельгии, Германии, Российской
Федерации, Туркменистану, Узбекистану и Швеции.
17
HIV/AIDS surveillance in Europe 2018 – 2017 data SURVEILLANCE REPORT
уровне за всю историю регистрации случаев ВИЧ- частях Региона наблюдается устойчивое увеличе-
инфицирования в течение года. Подавляющая доля ние числа случаев вновь диагностированных инфек-
случаев (82%) была диагностирована в восточной ций, связанных с определенными путями передачи,
части Региона и 16% в странах ЕС/ЕЭЗ. На случаи например, среди мужчин, имеющих половые кон-
ВИЧ-инфекции, впервые диагностированные в двух такты с мужчинами, на Западе и в Центре и среди
странах (Российская Федерация и Украина), прихо- гетеросексуалов на Востоке Региона. В последние
дится 75% всех случаев в Европейском регионе ВОЗ годы частота случаев передачи ВИЧ-инфекции при
и 92% случаев на Востоке Региона. Новые данные гетеросексуальных контактах существенно сократи-
эпиднадзора, представленные в этом обзоре, ука- лась в ЕС/ЕЭЗ и на Западе, особенно среди женщин,
зывают, с одной стороны, на продолжающееся уве- равно как и частота случаев передачи ВИЧ-инфекции
личение числа новых диагностированных случаев при половых контактах между мужчинами в отдель-
ВИЧ-инфекции в Европейском регионе и особенно ных странах ЕС/ЕЭЗ и на Западе. Во многих странах
в его восточной и центральной частях, несмотря на продолжала снижаться частота передачи ВИЧ при
снижение темпов роста показателей за последнее употреблении инъекционных наркотиков. Однако,
десятилетие по сравнению с предыдущими. С другой в 2017 г. на этот путь заражения в восточной части
стороны, данные подтверждают стабилизацию и даже Региона по-прежнему приходилось 37% новых заре-
снижение показателей в ряде стран ЕС/ЕЭЗ в послед- гистрированных случаев с известным путем зараже-
ние годы. ния.
Нынешние тенденции указывают на то, что Регион не У слишком большого числа людей во всем
сможет обеспечить достижение поставленных ВОЗ Европейском регионе диагноз ВИЧ-инфекции уста-
и Объединенной программой ООН по ВИЧ/СПИДу навливается на поздней стадии (53%), что повы-
(ЮНЭЙДС) целевых показателей (2–4), намеченных в шает риск развития заболеваний, летального исхода
качестве вех на пути к достижению Цели устойчивого и дальнейшего распространения ВИЧ-инфекции.
развития ООН (ЦУР) 3.3, которая призывает “поло- Большое число диагностированных случаев СПИДа
жить конец эпидемиям СПИДа, туберкулеза, малярии в восточной части Региона указывает на сохране-
и тропических болезней, которым не уделяется долж- ние таких серьезных проблем, как поздняя диагно-
ного внимания, и обеспечить борьбу с гепатитом, стика ВИЧ-инфекции, отсроченное начало АРТ и
заболеваниями, передаваемыми через воду, и дру- низкий охват лечением. В то же время тенденция к
гими инфекционными заболеваниями” (5). Расчетное стабилизации показателей заболеваемости СПИДом,
количество новых инфекций, которое в настоящее наблюдаемая с 2012 года, может быть результатом
время достигло исторического максимума, должно растущего большинства стран Востока, которые в
сократиться к 2020 г. на 78%, чтобы Регион смог настоящее время проводят так называемую политику
достичь этой цели. Даже в ЕС/ЕЭЗ, где общая тен- «Лечить всех», согласно которой АРТ предлагается
денция к повышению частоты новых случаев ВИЧ- всем людям, живущим с ВИЧ, независимо от стадии
инфекции несколько снизилась в последние годы, заболевания.
для достижения установленного целевого показателя
расчетное количество новых случаев должно быть Каждый пятый человек, живущий с ВИЧ в Регионе,
снижено на 74% к 2020 г. (рис. Е). не знает о своей инфекции (6) (более подробные дан-
ные приведены в докладе UNAIDS (7)). Для умень-
Хотя эпидемические модели и тенденции в разных шения числа людей с поздно диагностированной
странах Европы широко варьируются, в некоторых ВИЧ-инфекцией или людей, которые не знают о том,
Рисунок E. Расчетное число новых инфекций и новые диагностированные случаи в ЕС/ЕЭЗ и в Европейском
регионе ВОЗ, 2007–2017 гг., и цель на 2020 г.
Зарегистрированные новые диагностированные
160 000
Цель на 2020 г., Европейский регион ВОЗ
случаев инфицирования ВИЧ
140 000
Диагностированные случаи в
120 000
Европейском регионе ВОЗ
100 000
Расчетное число инфекций, ЕС/ЕЭЗ
80 000
Цель на 2020 г., ЕС/ЕЭЗ
60 000
Диагностированные случаи, ЕС/ЕЭЗ
40 000
20 000
0
2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
Источники: оценочное число новых случаев ВИЧ-инфекции – ЮНЭЙДС (7); новые диагностированные случаи ВИЧ-инфекции – авторы.
18
SURVEILLANCE REPORT HIV/AIDS surveillance in Europe 2018 – 2017 data
что они инфицированы, необходимы новые страте- мужчинами гомосексуальной ориентации из групп
гии по расширению разнообразных и удобных для риска и немедленном обращении выявленных ВИЧ-
пользователей подходов к повышению доступно- позитивных лиц за медицинской помощью и антире-
сти тестирования на ВИЧ. Руководство ВОЗ по само тровирусным лечением (19). Многокомпонентные
тестированию на ВИЧ и информированию партнеров вмешательства и включение в пакет мероприятий
и руководство ECDC по комплексному тестированию по противодействию ВИЧ-инфекции таких новых
на ВИЧ-инфекцию и гепатиты B и C содержат реко- стратегий, как доконтактная профилактика ВИЧ-
мендации о внедрении инновационных подходов, инфекции, самотестирование и оказание помощи
которые включают самотестирование и тестирова- в информировании полового партнера о нали-
ние, проводимое поставщиками услуг, не имеющими чии ВИЧ-инфекции, могут способствовать пре-
медицинского образования (8–10). Однако резуль- одолению этой восходящей тенденции (8,20,21).
таты мониторинга политики в рамках Региона сви- Увеличение в 2011–2012 гг. числа случаев ВИЧ-
детельствуют о том, что во многих европейских инфекции у людей, употребляющих инъекционные
странах внедрение таких подходов, как тестирова- наркотики, и продолжающиеся местные вспышки в
ние на уровне общин, самотестирование и оказание ряде стран (22–25) свидетельствует о необходимо-
помощи в добровольном информировании полового сти поддерживать или расширять программы сни-
партнера о наличии ВИЧ-инфекции, ограничено или жения вреда.
вообще отсутствует (11). Услуги по тестированию на
• В странах, расположенных в Центре, число новых
ВИЧ должны быть ориентированы на охват наибо-
случаев ВИЧ-инфекции в целом растет быстрее,
лее пострадавших групп населения с учетом местных
чем в любой другой части Европы. В этой части
эпидемиологических особенностей, быть адаптиро-
Региона наблюдаются большие различия в частоте
ваны к конкретным потребностям этих групп, а также
новых случаев ВИЧ-инфекции между мужчинами
содействовать своевременному охвату таких групп
и женщинами. Среди мужчин, особенно среди
диспансерным наблюдением, включающим такие
МСМ, наблюдается тревожный рост этого показа-
составляющие, как профилактика, диагностика и
теля по сравнению с довольно стабильной дина-
лечение ВИЧ-инфекции и оказание помощи ЛЖВ. Это
микой среди женщин. Половые контакты между
обеспечит раннюю диагностику и начало лечения и
мужчинами являются преобладающим путем пере-
приведет к улучшению результатов лечения и сниже-
дачи ВИЧ-инфекции в 12 из 15 стран в центральной
нию ВИЧ ассоциированной заболеваемости и смерт-
части Региона. Для улучшения ситуации помимо
ности в поддержку достижения целей «90-90-90»10 и
стратегий и практических мер, направленных на
других региональных и глобальных целей (2–4).
охват АРВ-терапией всех людей, живущих с ВИЧ,
В настоящее время уже имеются убедительные дока- необходимо следующее: внедрение услуг докон-
зательства того, что раннее начало АРТ полезно как тактной профилактики для групп высокого риска;
для здоровья человека, получающего лечение, так тестирование на ВИЧ, проводимое работниками,
и для предотвращения дальнейшей передачи ВИЧ не имеющими медицинского образования; экс-
(12–17). Почти 90% стран Европейского региона ВОЗ пресс-тестирование на ВИЧ; самотестирование
имеют политику предоставления лечения незави- на ВИЧ; и оказание профессиональной помощи в
симо от количества лимфоцитов CD4 (6,18). добровольном уведомлении полового партнера.
Некоторые страны перешли на внутреннее финан-
Меры по противодействию эпидемии ВИЧ-инфекции сирование мер противодействия ВИЧ-инфекции
должны основываться на научных данных и они после прекращения финансирования со стороны
должны быть адаптированы к национальной и мест- Глобального фонда для борьбы со СПИДом, тубер-
ной эпидемиологической ситуации. На основании кулезом и малярией. Это создает проблемы устой-
данных эпиднадзора, приведенных в этом докладе, чивости, особенно в отношении финансирования
можно сделать следующие выводы: программ профилактики ВИЧ-инфекции. Для смяг-
чения некоторых из этих проблем и предотвраще-
• Что касается стран ЕС/ЕЭЗ и западной части
ния ускорения темпов распространения эпидемии
Региона, то ввиду повышения частоты ВИЧ-
необходимы более активная политическая воля и
инфицирования среди МСМ в некоторых стра-
внимание наряду с более активным участием граж-
нах и преобладания передачи ВИЧ среди МСМ
данского общества (26).
существующие мероприятия по профилактике и
борьбе с ВИЧ-инфекцией должны быть расширены • В странах восточной части Региона существует
и укреплены, оставаясь приоритетным направ- настоятельная необходимость расширить мас-
лением противодействия ВИЧ-инфекции. Страны штабы смелых и научно-обоснованных мер и
со снижением показателей продемонстрировали обеспечить предоставление гражданам эффектив-
влияние изменения культуры поведения, выра- ных, высококачественных и комплексных услуг с
жающееся в более частом прохождении тестов помощью хорошо функционирующих систем здра-
воохранения, одной из задач которых является
улучшение социальных детерминант здоровья.
10 Цели “90-90-90” заключаются в том, что 90% людей,
живущих с ВИЧ, должны знать свой ВИЧ-статус, 90% людей с
Имеется необходимость в комплексных стратегиях
диагностированной ВИЧ-инфекцией должны получать лечение и комбинированной профилактики и во внедрении
у 90% людей, проходящих лечение, должна быть неопределяемая
вирусная нагрузка. инновационных способов тестирования на ВИЧ,
19
HIV/AIDS surveillance in Europe 2018 – 2017 data SURVEILLANCE REPORT
уделяя особое внимание охвату ключевых групп Благодаря этой инициативе был подготовлен первый
населения. Это может быть достигнуто с помо- сборник примеров передовой практики в сфере про-
щью удобных для пользователя услуг по профи- тиводействия ВИЧ-инфекции в 33 государствах-чле-
лактике ВИЧ-инфекции и тестированию на ВИЧ, нах Европейского региона ВОЗ (29).
включая оказание профессиональной помощи в
добровольном уведомлении полового партнера, Надежные эпидемиологические данные имеют реша-
доконтактную профилактику, тестирование на ВИЧ, ющее значение для мониторинга ситуации и при-
проводимое обученными поставщиками услуг, не нятия службами общественного здравоохранения
имеющими медицинского образования, и само информированных решений относительно своевре-
тестирование в соответствии с рекомендациями менных и эффективных мер противодействия эпи-
ВОЗ. Все эти виды услуг должны быть интегриро- демии ВИЧ-инфекции в Европейском регионе ВОЗ.
ваны в национальную политику и программы и вне- Постепенно увеличивается число стран, которые про-
дрены в практику (4,8,9,27). Участие общественных водят расширенный эпиднадзор за ВИЧ-инфекцией и
организаций в разработке и предоставлении сообщают собранные эпидемиологические данные на
лечебно-профилактических услуг имеет решаю- европейский уровень. В 2017 г. 41 страна предоста-
щее значение для сокращения числа новых случаев вила связанные данные о случаях ВИЧ-инфекции и
инфицирования ВИЧ и увеличения числа людей, СПИДа, что позволяет лучше понять клинический ста-
охваченных диспансерным наблюдением и полу- тус людей с диагностированной ВИЧ-инфекцией. Этот
чающих АРТ, с конечной целью снижения большого подход расширяет возможности долгосрочного мони-
количества случаев СПИДа, в том числе с летальным торинга результатов оказания медицинской помощи
исходом. Инновационные мероприятия по профи- при ВИЧ-инфекции, например, путем моделирова-
лактике ВИЧ-инфекции должны быть направлены ния доли недиагностированных случаев инфекции и
на снижение риска гетеросексуальной передачи, количественной оценки таких параметров, как охват
особенно среди пар, где один из партнеров скло- людей с диагностированной ВИЧ-инфекцией диспан-
нен к поведению высокого риска (например, упо- серным наблюдением и АРВ-терапией и подавление
требляет инъекционные наркотики) или в течение вирусной нагрузки. Он может также внести вклад в
длительных периодов времени находится за грани- национальные и глобальные усилия по мониторингу
цей. Большое количество новых диагностирован- достижения целей «90-90-90» и других глобальных и
ных случаев ВИЧ-инфекции у людей, зараженных региональных целей.
при употреблении инъекционных наркотиков, ука-
зывает на то, что основанная на фактических дан- Библиография11
1. Справка «ВИЧ-инфекция в Российской Федерации на 31 декабря
ных политика, направленная на ключевые группы 2017 г.» Москва: Федеральный научно-методический центр по
населения и предусматривающая широкий охват профилактике и борьбе со СПИДом, Российская Федерация,
2018 г.
людей, употребляющих инъекционные наркотики,
2. Глобальная стратегия сектора здравоохранения по борьбе с
программами снижения вреда, по-прежнему имеет ВИЧ-инфекцией на 2016-2021 годы: на пути к ликвидации СПИДа
Женева: Всемирная организация здравоохранения; 2016 г.
решающее значение для эффективного противо- (http://www.who.int/hiv/strategy2016-2021/ghss-hiv/ru/)
действия ВИЧ-инфекции в восточной части Региона. 3. Ambitious treatment targets: writing the final chap-
После ряда призывов к принятию срочных мер, ter of the AIDS epidemic. Geneva: UNAIDS; 2014 (http://
w w w. u n a i d s . o r g /s i t e s/d e f a u l t /f i l e s/m e d i a _ a s s e t /
самым недавних из которых был призыв дирек- JC2670_UNAIDS_Treatment_Targets_en.pdf).
тора Европейского регионального бюро ВОЗ в ходе 4. План действий сектора здравоохранения по борьбе с ВИЧ-
инфекцией в Европейском регионе ВОЗ (на англ. яз.). Копенгаген:
министерского диалога по вопросам политики в Европейское региональное бюро ВОЗ, 2017 г.(http://www.euro.
отношении ВИЧ-инфекции и сочетанных заболева- who.int/en/health-topics/communicable-diseases/hivaids/publi-
cations/2017/action-plan-for-the-health-sector-response-to-hiv-in-
ний в Восточной Европе и Центральной Азии (ВЕЦА) the-who-european-region-2017).
с участием 11 министров или заместителей мини- 5. Цели устойчивого развития Организации Объединенных
стров здравоохранения из 11 стран ВЕЦА в июле Наций. About the Sustainable Development Goals. Источник:
Организация Объединенных Наций [веб-сайт]. Нью-Йорк:
2018 г. (28), страны восточной части Региона акти- Организация Объединенных Наций, 2018 г. (https://www.un.org/
sustainabledevelopment/sustainable-development-goals/).
визировали усилия по осуществлению Плана
6. Monitoring implementation of the Dublin Declaration on Partnership
действий сектора здравоохранения по борьбе с to fight HIV/AIDS in Europe and Central Asia: thematic report on the
ВИЧ-инфекцией в Европейском регионе ВОЗ, в том HIV continuum of care: Stockholm: ECDC; in press.
7. Annex on methods. In: Miles to go. Global AIDS update 2018.
числе путем разработки дорожных карт для уско- UNAIDS; 2018:255–64 (http://www.unaids.org/sites/default/files/
рения усилий по достижению целевых показателей media_asset/miles-to-go_en.pdf).
ЮНЭЙДС и стратегии ВОЗ Здоровье-2020 (2–4). 8. Руководство самотестированию на ВИЧ и информированию
партнеров. Дополнение к сводному руководству по услугам
тестирования на ВИЧ. Женева: Всемирная организация
Для содействия обмену накопленным опытом в здравоохранения; 2017 г. (http://www.euro.who.int/__data/
assets/pdf_file/0003/380496/hiv-self-testing-2018-rus.pdf?ua=1).
рамках Европейского региона ВОЗ национальным
9. Сводное руководство по услугам тестирования на ВИЧ. Женева:
органам здравоохранения, национальным и между- Всемирная организация здравоохранения; 2016 г. (http://www.
народным экспертам и организациям гражданского euro.who.int/__data/assets/pdf_file/0004/317659/Consolidated-
guidelines-HIV-testing-services-2015-ru.pdf)
общества, занимающимся оказанием услуг по профи- 10. Public health guidance on HIV, hepatitis B and C testing in the EU/
лактике, диагностике и лечению ВИЧ-инфекции, было EEA. Stockholm: ECDC; 2018 (https://ecdc.europa.eu/sites/portal/
предложено поделиться информацией о своих успеш-
ных мерах и программах по борьбе с ВИЧ-инфекцией. 11 Все веб-ссылки, приведенные в этом обзоре и последующих
главах, были доступны по состоянию на 12 ноября 2018 г.
20
SURVEILLANCE REPORT HIV/AIDS surveillance in Europe 2018 – 2017 data
f iles/documents/HIV-hepatitis-B-and-C-testing-public-health- 21. McCormack S, Dunn DT, Desai M, Dolling DI, Gafos M, Gilson R et al.
guidance.pdf). Pre-exposure prophylaxis to prevent the acquisition of HIV-1 infec-
11. HIV testing. Monitoring implementation of the Dublin Declaration on tion (PROUD): effectiveness results from the pilot phase of a prag-
Partnership to fight HIV/AIDS in Europe and Central Asia: 2017 pro- matic open-label randomised trial. Lancet 2017;378:53–60.
gress report. Stockholm: ECDC; 2017 (https://ecdc.europa.eu/sites/ 22. Hedrich D, Kalamara E, Sfetcu O, Pharris A, Noor A, Wiessing
portal/files/documents/HIV%20testing.pdf). L et al. Human immunodeficiency virus among people who
12. Сводное руководство по использованию антиретровирусных inject drugs: is risk increasing in Europe? Euro Surveill.
препаратов для лечения и профилактики ВИЧ-инфекции. 2013;18(48):pii=20648. (http://www.eurosurveillance.org/
Рекомендации с позиций общественного здравоохранения. ViewArticle.aspx?ArticleId=20648).
Второе издание. Женева: Всемирная организация 23. Giese C, Igoe D, Gibbons Z, Hurley C, Stokes S, McNamara S et
здравоохранения; 2016 г. (http://www.who.int/hiv/pub/arv/ al. Injection of new psychoactive substance snow blow asso-
arv-2016/ru/) ciated with recently acquired HIV infections among homeless
13. Руководство о времени назначения антиретровирусной терапии people who inject drugs in Dublin, Ireland, 2016. Euro Surveill.
и по доконтактной профилактике ВИЧ-инфекции. Женева: 2016;20(40):pii=30036. doi:http://dx.doi.org/10.2807/1560-7917.
Всемирная организация здравоохранения; 2016 г. (http://www. ES.2016.20.40.30036.
euro.who.int/_ _data/assets/pdf_file/0008/310301/Guideline- 24. Public Health England, Health Protection Scotland, Public Health
when-start-ATP-HIV-ru.pdf?ua=1) Wales, Public Health Agency Northern Ireland. Shooting up: infec-
14. INSIGHT START Study Group. Initiation of antiretroviral tions among people who inject drugs in the UK, 2016. London:
therapy in early asymptomatic HIV infection. N Engl J Med. Public Health England; 2017 (https://www.gov.uk/government/
2016;373(9):795–807. uploads/system/uploads/attachment_data/file/567231/Shooting_
Up_2017_Update.pdf).
15. Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC,
Kumarasamy N et al. Prevention of HIV-1 infection with early antiret- 25. HIV in people who inject drugs – joint technical mission to
roviral therapy. N Engl J Med. 2011;365(6):493–505. Luxembourg. Stockholm, Lisbon: ECDC/European Monitoring Centre
for Drugs and Drug Addiction; 2018 (http://sante.public.lu/fr/
16. Guidelines version 9.0. October 2017. Brussels: European publications/h/hiv-joint-technical-mission/index.html).
AIDS Clinical Society; 2017 (http://www.eacsociety.org/files/
guidelines_9.0-english.pdf). 26. Lost in transition. Three case studies of Global Fund withdrawal in
south eastern Europe. New York (NY): Open Society Foundations;
17. Rodger A, Cambiano V, Bruun T, Vernazza P, Collins S, Corbelli CM 2017 (https://www.opensocietyfoundations.org/publications/
et al. Risk of HIV transmission through condomless sex in gay cou- lost-transition).
ples with suppressive ART: the PARTNER2 study expanded results
in gay men. In: AIDS 2018. 22nd International AIDS Conference, 27. Consolidated guidelines on HIV prevention, diagnosis, treatment
Amsterdam, the Netherlands, 23–27 July 2018 [website]. Geneva: and care for key populations. 2016 update. Geneva: World Health
International AIDS Society; 2018 (Abstract WEAX0104LB, 2018; Organization; 2016 (https://www.who.int/hiv/pub/guidelines/
https://programme.aids2018.org/Abstract/Abstract/13470). keypopulations-2016/en/)).
18. 2017 global AIDS monitoring (GAM). In: AIDSinfo [website]. New Yorl 28. Министерский диалог по вопросам политики в отношении ВИЧ-
(NY): UNAIDS; 2017 (www.AIDSinfoonline.org). инфекции и сочетанных заболеваний в Восточной Европе и
Центральной Азии. Источник: Европейское региональное бюро
19. Brown AE, Mohammed H, Ogaz D, Kirwan PD, Yung M, Nash SG. Fall ВОЗ [веб-сайт]. Копенгаген: Европейское региональное бюро
in new HIV diagnoses among men who have sex with men (MSM) ВОЗ, 2018 г. (http://www.euro.who.int/ru/media-centre/events/
at selected London sexual health clinics since early 2015: test- events/2018/07/ministerial-policy-dialogue-on-hiv-and-related-
ing or treatment or pre-exposure prophylaxis (PrEP)? Euro Surv comorbidities-in-eastern-europe-and-central-asia).
eill. 2017;22(25):pii=30553 (https://doi.org/10.2807/1560-7917.
ES.2017.22.25.30553). 29. Сборник примеров передовой практики здравоохранения в
сфере противодействия ВИЧ-инфекции в Европейском регионе
20. HIV and STI prevention among men who have sex with men. ECDC ВОЗ. Копенгаген: Европейское региональное бюро ВОЗ, 2018 г.
guidance. Stockholm: ECDC; 2014 (http://ecdc.europa.eu/en/pub- (http://www.euro.who.int/en/publications/abstracts/compendium-
lications/Publications/hiv-sti-prevention-among-men-who-have- of-good-practices-in-the-health-sector-response-to-hiv-in-the-
sex-with-men-guidance.pdf). who-european-region).
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SURVEILLANCE REPORT HIV/AIDS surveillance in Europe 2018 – 2017 data
Fig. 1.1. Male-to-female ratio in new HIV diagnoses, by country, EU/EEA, 2017 (n = 25 210)
Croatia
Slovenia
Slovakia
Czech Republic
Bulgaria
Hungary
Poland
Iceland
Netherlands
Spain
Lithuania
Austria
Greece
Denmark
Malta
Cyprus
Italy
Ireland
EU/EEA
United Kingdom
Romania
Luxembourg
Norway
Portugal
Belgium
Estonia
France
Latvia
Finland
Sweden
0 4 8 12 16 20 24
Male-to-female ratio
23
HIV/AIDS surveillance in Europe 2018 – 2017 data SURVEILLANCE REPORT
transmission was known, accounting for more than of transmission for one quarter or more of the cases
60% of new HIV diagnoses in 10 countries (Austria, reported in Lithuania (62%), Iceland (33%) and Latvia
Croatia, the Czech Republic, Hungary, Ireland, the (33%) (Fig. 1.5).
Netherlands, Poland, Slovakia, Slovenia and Spain)
• Of the remainder, 136 diagnoses (less than 1%) were
(Fig. 1.5).
reported as being due to vertical transmission during
• Sex between men and women is the second most pregnancy, childbirth or breastfeeding (Table 7); 82
commonly reported mode of transmission in the of these cases (60%) were born outside of the coun-
EU/EEA, accounting for 33% (8402) of HIV diagnoses try in which the case was later reported. Fifty-nine
and 44% of diagnoses where the route of transmis- diagnoses were reported to be due to contaminated
sion was known (Table 6, Table 8, Fig. 1.5). These transfusion of blood and its products, and 10 to
proportions are divided roughly equally between men hospital-acquired infections (Table 8). Nearly all of
and women. Heterosexual transmission is the most these nosocomial and transfusion-related cases were
commonly reported known mode of transmission in reported to have been acquired outside of the country
10 EU/EEA countries (Estonia, Finland, France, Italy, where the case was reported (Table 12a).
Latvia, Luxembourg, Norway, Portugal, Romania and
Sweden). More than one third (37%; 1982) of newly • Transmission mode was reported as unknown for
diagnosed cases due to heterosexual transmission 6123 diagnoses (24%), with wide variation among
are among migrants originating from countries with countries: less than 5% of diagnoses were reported
generalized HIV epidemics. The highest proportions as unknown in Bulgaria, Croatia, Cyprus, the Czech
of these were observed in Ireland (58%), France (52%) Republic, Norway, Portugal and Romania, and over
and Sweden (51%) (Table 10). 60% in Iceland and Poland (Table 8).
• Four per cent (929 cases) of new HIV diagnoses over- Young people aged 15 to 24 years comprised 12% of the
all and 5% with known route of HIV transmission EU/EEA population and 12% of HIV diagnoses in 2017.
were attributed to injecting drug use (Table 5, Table Romania and Hungary reported more than 15% of their
8, Fig. 1.5). Injecting drug use was the probable route HIV diagnoses in this age group (Fig. 1.4). Thirty-nine
Fig. 1.2. Age- and gender-specific rates of new HIV diagnoses per 100 000 population, EU/EEA, 2017 (n = 25 210)
25 Women
New HIV diagnoses per 100 000 population
Men
20
15
10
0
< 15 15–19 20–24 25–29 30–39 40–49 50+
Age category (years)
Fig. 1.3. New HIV diagnoses, by age group (in years) and transmission mode, EU/EEA, 2017
15–19 years
Heterosexual contact n = 8397 20–24 years
25–29 years
Transmission mode
30–39 years
0 20 40 60 80 100
Percentage
24
SURVEILLANCE REPORT HIV/AIDS surveillance in Europe 2018 – 2017 data
per cent of the EU/EEA population is considered to Finland, France, Iceland, Ireland, Luxembourg, Malta,
consist of older adults (50 years and above), who con- Norway, Sweden and the United Kingdom.
tributed 19% of new HIV diagnoses reported in 2017. In
the Netherlands, Portugal and Slovenia, older adults About 4% of people diagnosed with HIV in the EU/EEA
comprised more than 25% of those newly diagnosed in 2017 were reported to have been previously diag-
with HIV (Table 9). nosed with HIV in another country prior to their 2017
diagnosis in the reporting country (data not shown). The
Twenty-eight EU/EEA countries provided information on proportion of 2017 diagnoses that had previously been
the country of birth, country of nationality or region of diagnosed was higher than the EU/EEA average in some
origin for 21 184 (84%) HIV diagnoses in 2017 (Fig. 1.6). countries, including Cyprus (29%), the Czech Republic
In the EU/EEA, 8711 diagnoses (41% of those with known (13%), Denmark (41%), Iceland (29%), Ireland (34%),
information on region of origin) were made among peo- France (7%), Malta (33%), Norway (24%) and Sweden
ple originating from outside of the reporting country. (34%).
Of these, 3723 (18% of those with known information
on region of origin), irrespective of transmission mode, Information on CD4 cell count at the time of HIV diag-
were among people originating from countries with gen- nosis was provided by 25 countries (Table 14) for 16
eralized HIV epidemics (Fig. 1.6, Table 11). An additional 585 (72%) adults and adolescents diagnosed in those
23% of new diagnoses with known region of origin (4988 countries. All countries reporting such data were able to
cases) were among people born outside of the reporting provide CD4 cell counts for 50% or more of their reported
country, but did not originate from a country experienc- cases, apart from Estonia, Lithuania and France, which
ing a generalized epidemic, including 8% from countries provided data for 36%, 40% and 45% of new diagnoses,
in Latin America and the Caribbean (1709 cases), 6% respectively. Nearly half (49%) of all cases with a CD4
from other countries in central and eastern Europe (1310 cell count available were considered to have been diag-
cases) and 4% from other countries in western Europe nosed several years after being infected, with a count
(828 cases). Countries with at least half of their new HIV of below 350 cells per mm3, including 28% of cases
diagnoses among people originating from outside of considered to have advanced HIV infection (CD4 < 200
the reporting country were Belgium, Denmark, Cyprus, cells/mm3). The proportion of those diagnosed late, with
a CD4 count below 350 cells per mm3, was above 60%
Fig. 1.4. Percentage of new HIV diagnoses, by country and age group, EU/EEA, 2017 (n = 25 255)
Malta < 15 years
Finland
Luxembourg 15–19 years
Lithuania 20–24 years
Greece
Latvia 25–29 years
Slovenia 30–39 years
Belgium
40–49 years
Norway
Portugal ≥ 50 years
Croatia
Estonia
France
Denmark
Austria
Slovakia
Italy
EU/EEA
United Kingdom
Sweden
Spain
Netherlands
Bulgaria
Ireland
Poland
Hungary
Czech Republic
Cyprus
Iceland
Romania
0 20 40 60 80 100
Percentage
Note: Germany did not report data for 2017, and no cases were reported by Liechtenstein.
25
HIV/AIDS surveillance in Europe 2018 – 2017 data SURVEILLANCE REPORT
Fig. 1.5. Percentage of new HIV diagnoses with known mode of transmission, by transmission route and country,
EU/EEA, 2017 (n = 19 230)
Croatia Sex between men
Hungary Heterosexual contact (males)
Slovakia
Heterosexual contact (females)
Netherlands
Czech Republic Injecting drug use
Slovenia Other
Poland
Austria
Spain
Ireland
Malta
Cyprus
Greece
United Kingdom
Denmark
EU/EEA
Bulgaria
Belgium
France
Iceland
Italy
Norway
Portugal
Sweden
Finland
Luxembourg
Romania
Estonia
Latvia
Lithuania
0 20 40 60 80 100
Percentage
Note: Germany did not report data for 2017, and no cases were reported by Liechtenstein; unknown route of transmission is excluded from proportions presented
here.
Fig. 1.6. Percentage of new HIV diagnoses among migrants out of all reported cases with known information on region
of origin, by country of report, EU/EEA, 2017 (n = 21 184)
Note: Germany did not report data for 2017, and no cases were reported among people born abroad in Hungary and Liechtenstein.
26
SURVEILLANCE REPORT HIV/AIDS surveillance in Europe 2018 – 2017 data
among cases with known CD4 cell count at diagnosis in those diagnosed in 2017 were linked to care within three
Lithuania (66%) and Latvia (62%). months of HIV diagnosis.
Fig. 1.7. Percentage of people diagnosed late (CD4 cell count < 350 per mm3) by demographic, EU/EEA, 2017
Total
Gender
Men
Women
15–19
Age group (years)
20–24
25–29
30–39
40–49
50+
Heterosexual men
Transmission
Heterosexual women
Injecting drug use
Sex between men
Western Europe
Central and eastern Europe
Latin America and Caribbean
South and south-east Asia
Sub-Saharan Africa
0 10 20 30 40 50 60 70
Percentage
Note: cases with unknown CD4 count are excluded from proportions presented here.
27
HIV/AIDS surveillance in Europe 2018 – 2017 data SURVEILLANCE REPORT
Fig. 1.8. People diagnosed with HIV, AIDS and deaths reported per 100 000 population, EU/EEA, 2008–2017
8 HIV
New HIV diagnoses per 100 000 population
7 AIDS
AIDS-related death
6
0
2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
Year of diagnosis
Note: rates exclude countries not reporting consistently over the period: Belgium and Sweden (AIDS and AIDS-deaths), Italy (AIDS deaths) and Germany (AIDS, AIDS
deaths and HIV).
Trends differ by gender and age group. Age-specific 2008 and 19% in 2017 were made in men of 50 or above
rates have declined since 2008 in all age groups except (data not shown).
for adults over 50 years, with rates among 25–29-year-
olds and 30–39-year-olds consistently higher than HIV diagnoses among people born outside of the report-
other groups throughout the period in both women and ing country comprised 44% of all new diagnoses in
men. Age-specific rates in women have declined more 2008, decreasing slightly to 37% in 2013 and increasing
markedly in women under 40 years, while rates among to 41% in 2017 (Fig. 1.10). New diagnoses among people
women 40 years and older have been stable. Among originating from sub-Saharan Africa decreased from
men, rates among 20–29-year-olds peaked in 2015 and 24% of all new diagnoses in 2008 to 18% in 2017, while
have declined since. Rates in men aged 30–49 years new diagnoses among people originating from other
have declined during the period. Rates in males aged countries in central and eastern Europe increased from
15–19 years and men over 50 have remained stable (Fig. 4% to 6% of all new diagnoses. The proportion of people
1.9a, 1.9b). originating from other regions has remained stable.
The median age at HIV diagnosis increased from 35 years Since 2008, most EU/EEA countries have consistently
in 2008 to 37 years in 2017 overall (from 33 to 37 years reported data on transmission mode. Data from Estonia
among women and 36 to 37 in men). A larger proportion and Poland were excluded from EU/EEA presentation
of diagnoses is being reported in older age groups; 13% of trends (Fig. 1.11a, 1.11b, 1.12), as more than 50% of
of people diagnosed in 2008 were over 50 years at HIV the data on transmission mode were missing. Data from
diagnosis, rising to 19% in 2017. In women, 11% of diag- Spain and Italy were also excluded because coverage
noses in 2007 and 19% in 2017 were made in those aged by the surveillance system has been gradually expand-
50 years or above, while in men, 14% of diagnoses in ing on a national basis over the last decade. Germany
did not report data for 2017. Data on transmission mode
25–29 years
30–39 years
15
40–49 years
20–24 years
10
5
≥ 50 years
15–19 years
0
2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
Year of diagnosis
28
SURVEILLANCE REPORT HIV/AIDS surveillance in Europe 2018 – 2017 data
12
9
30–39 years
25–29 years
6
40–49 years
20–24 years
3
15–19 years
≥ 50 years
0
2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
Year of diagnosis
Fig. 1.10. Percentage of new diagnoses among people born abroad, by year of diagnosis and region of origin, EU/EEA,
2008–2017
50 Sub-Saharan Africa
Central and Eastern Europe
40 Western Europe
Latin America and Caribbean
30 South and Southeast Asia
Percentage
Other
20
10
0
2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
Year of diagnosis
Note: data from 27 EU/EEA countries included. HIV diagnoses reported by Estonia and Poland excluded due to incomplete reporting on transmission mode during
some years of the period; diagnoses reported by Italy and Spain excluded due to increasing national coverage during the period
Fig. 1.11a. HIV diagnoses, by year of diagnosis and transmission mode, adjusted for reporting delay, EU/EEA,
2008–2017
10 000 Sex between men
Heterosexual (women)
8000 Heterosexual (men)
Number of HIV diagnoses
2000
0
2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
Year of diagnosis
Note: data from 26 EU/EEA countries included. HIV diagnoses reported by Estonia and Poland excluded due to incomplete reporting on transmission mode during
some years of the period; diagnoses reported by Germany, Italy and Spain excluded due to incomplete reporting during a portion of the period.
29
HIV/AIDS surveillance in Europe 2018 – 2017 data SURVEILLANCE REPORT
from those countries consistently reporting indicate the the same extent as observed in EU/EEA-native MSM
trends below. (Fig. 1.12).
• The proportion of all HIV diagnoses attributed to sex • The number of heterosexually acquired cases
between men increased from 34% of cases in 2008 to decreased steadily in women, from 5638 in 2008 to
41% in 2014 and 2015, then decreased to 37% in 2017. 2949 in 2017, and in men, from 4577 to 2747 during
The number of HIV diagnoses reported among MSM in the same period (Fig. 1.11a). The proportion of all HIV
countries reporting consistently increased from 7369 diagnoses attributed to heterosexually acquired infec-
cases in 2008 and peaked at 8297 in 2013. Although tion in women decreased from 26% of cases in 2008
fewer cases were reported in 2017 (6294), reporting to 17% in 2017, and to heterosexually acquired infec-
delay probably plays a partial role in this decline. tion in men from 21% to 16% over the same period
Most of the decline appears to be due to fewer diagno- (Fig. 1.11b). The number of cases among women and
ses among MSM in Belgium, Greece, the Netherlands, foreign-born heterosexuals between 2008 and 2017
Spain and the United Kingdom. Increases were decreased at a greater rate than cases among men and
observed in many EU/EEA countries between 2008 non-foreign-born people (Fig. 1.11a, 1.12). The decline
and 2017 (Table 4), with substantial increases noted in in foreign-born cases is mainly due to sharp decreases
Bulgaria, Cyprus, Ireland, Malta, Poland and Romania among migrants originating from countries with gen-
in recent years. Cases attributed to MSM born outside eralized HIV epidemics (6291 in 2008 and 3723 in
of the reporting country increased over the period, 2017). Despite the overall decline in heterosexually
declining slightly between 2015 and 2017 but not to
Fig. 1.11b. Percentage of HIV diagnoses, by year of diagnosis and transmission mode, adjusted for reporting delay, EU/
EEA, 2008–2017
100 Sex between men
Heterosexual (women)
80 Heterosexual (men)
Injecting drug use
60 Vertical transmission
Percentage
Other/undetermined
40
20
0
2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
Year of diagnosis
Note: data from 26 EU/EEA countries included. HIV diagnoses reported by Estonia and Poland excluded due to incomplete reporting on transmission mode during
some years of the period; diagnoses reported by Germany, Italy and Spain excluded due to incomplete reporting during a portion of the period.
Fig. 1.12. New HIV diagnoses, by year of diagnosis, transmission and migration status, EU/EEA, 2008–2017
2000
1000
0
2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
Year of diagnosis
Note: data from 26 EU/EEA countries included. HIV diagnoses reported by Estonia and Poland excluded due to incomplete reporting on transmission mode during
some years of the period; diagnoses reported by Germany, Italy and Spain excluded due to incomplete reporting during a portion of the period.
30
SURVEILLANCE REPORT HIV/AIDS surveillance in Europe 2018 – 2017 data
acquired cases during this period, new diagnoses in • Reporting delays differ significantly among trans-
Estonia and Lithuania increased substantially. mission categories for some countries. When
standardized adjustments for reporting delay are
• The number of HIV diagnoses reported among peo-
introduced, they increase the number of reported HIV
ple who inject drugs has also declined since 2007
cases in all transmission categories by between 8%
(from 1091 cases to 689) in both foreign-born and
and 19%, depending on the category. Fig. 1.9a, 1.11a
non-foreign-born people (Fig. 1.11a, 1.12). A tempo-
and 1.12 show these adjusted trends.
rary increase in overall numbers for the EU/EEA was
observed in 2011 and 2012 due to localized outbreaks • While many people are still diagnosed late, several
reported in Greece and Romania, but the overall down- years after being infected with HIV, the median CD4
ward trend in the number of reported cases continued cell count at HIV diagnosis has increased significantly
for the EU/EEA in 2017 (Table 5). Although diagnoses over the past decade, from 330 (95% CI: 322–338)
attributed to injecting drug use nearly tripled between cells/mm3 in 2008 to 391 (95% CI: 381–400) cells/
2015 and 2017 in Lithuania, other countries, such as mm3 in 2017. The group with the highest median CD4
Austria, Belgium, Estonia, France, Italy, Portugal and cell count at diagnosis is MSM, with 452 cells/mm3
Spain, have seen a sharp decrease in the rate of HIV in 2017. This has also improved over the last dec-
diagnoses due to injecting drug use over the last ade, however, indicating earlier diagnosis (Fig. 1.13).
decade. Median CD4 count at diagnosis was lower in cases
attributed to heterosexual transmission but similarly
• The number of diagnoses reported to be due to verti-
increased over the period (from 290 cells/mm3 in 2008
cal transmission of HIV decreased from 258 in 2008
to 347 cells/mm3 in 2017 in women, and 239 cells/mm3
to 115 in 2017 (Fig. 1.11a). Throughout the period,
in 2008 to 278 cells/mm3 in 2017 in men).
between two thirds and three quarters of these cases
originated from outside the reporting country.
• The number of HIV diagnoses reported to be due to
AIDS cases, morbidity and
nosocomial infection has remained stable over the mortality
period, with 12 cases in 2008 and nine in 2017. The Despite improvements in early diagnosis of HIV, 3130
number of cases reported to be due to contaminated diagnoses of AIDS were reported by 28 EU/EEA coun-
transfusion of blood and its products decreased from tries12 in 2017, giving a rate of 0.7 cases per 100 000
78 in 2008 to 48 in 2017. A large and growing pro- population (Table 15). The highest rate was reported by
portion of these cases was among people who had Latvia (6.0 per 100 000 population; 118 cases). Overall,
migrated to the EU/EEA and were later diagnosed in 89% of AIDS diagnoses were made within 90 days of
the reporting country (50% in 2008 to 77% in 2017 the HIV diagnosis. The only group where more than half
among nosocomial cases, and 78% in 2008 to 86% in of AIDS cases (59%) occurred after the immediate HIV
2017 among transfusion-related cases). diagnosis was among people whose HIV infection was
• The number of cases with an unknown mode of trans- attributed to injecting drug use (Fig. 1.14).
mission increased from 2848 in 2008 to 4178 in 2017
(13% of cases in 2008 and 24% in 2017). This increase
is affected by reporting delay and will probably
decrease slightly in future reporting. 12 This included all EU/EEA countries except Belgium, Germany and
Sweden.
Fig. 1.13. Median CD4 cell count per mm3 at HIV diagnosis, by year of diagnosis and transmission group, EU/EEA,
2008–2017
500 Sex between men
Heterosexual (women)
CD4 cell count/mm3 at diagnosis
200
100
0
2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
Year of diagnosis
Note: excludes countries with > 60% incomplete data on CD4 cell count during any year over the period (Bulgaria, Croatia, Estonia, Germany, Hungary, Italy, Ireland,
Latvia, Lithuania, Malta, Norway, Poland, Portugal and Sweden). Acute infections are excluded from this analysis.
31
HIV/AIDS surveillance in Europe 2018 – 2017 data SURVEILLANCE REPORT
The rate of reported AIDS cases has halved in the last Twenty-seven EU/EEA countries (all but Belgium,
decade, from 1.6 per 100 000 reported in 2008 (Fig. Germany, Italy and Sweden, which did not report consist-
1.8). This decline is noted in men and women and in all ently over the period) reported data on deaths of people
transmission groups, but appears greatest among cases diagnosed with AIDS. Overall, 772 were reported to
attributed to heterosexual transmission and injecting have died due to AIDS-related causes during 2017 (Table
drug use (Tables 16–22, Fig. 1.15). Despite the general 24), although these data are affected by underreport-
EU/EEA-wide decline, an increase has been reported in ing due to the challenges in many countries in linking
the rate of AIDS diagnoses since 2008 in Bulgaria, the to death registries. Nevertheless, AIDS-related death
Czech Republic and Hungary. reports have consistently been decreasing since 2008,
when 2147 deaths were reported in countries reporting
The most common AIDS-indicative diseases diagnosed consistently over time, although delays in reporting and
in 2017 in the EU/EEA were Pneumocystis pneumonia underreporting may affect the latest figures (Table 25,
(21%), pulmonary and/or extrapulmonary TB (14%), Fig. 1.8). From the beginning of the HIV epidemic to the
wasting syndrome due to HIV (11%) and oesophageal end of 2017, the cumulative total of people diagnosed
candidiasis (10%) (Table 23). Seventeen countries with AIDS in the EU/EEA is 358 722 (Table 15). The cumu-
reported TB (pulmonary and/or extrapulmonary) as an lative total of cases reported as known to have died due
AIDS-defining illness in people newly diagnosed with to AIDS-related causes by the end of 2017 was 188 638
AIDS in 2017. Fourteen per cent of people diagnosed with (Table 24).
AIDS in these countries presented with TB as an AIDS-
defining illness, ranging from 6% of cases in Finland to
more than 35% in Romania (Fig. 1.16). HIV testing
Fourteen countries reported data on HIV tests performed,
excluding unlinked anonymous testing and testing of
Fig. 1.14. Percentage of AIDS diagnoses within 90 days of HIV diagnosis, EU/EEA, 2017 (n = 1671)
Heterosexual
transmission (males)
Heterosexual
transmission (females)
0 20 40 60 80 100
Percentage
800
400
0
2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
Year of diagnosis
Note: data from Germany, Belgium and Sweden excluded due to inconsistent reporting during the period.
32
SURVEILLANCE REPORT HIV/AIDS surveillance in Europe 2018 – 2017 data
Fig. 1.16. Percentage of people diagnosed with AIDS with TB as an AIDS-defining illness, EU/EEA, 2017 (n = 2825)
Romania
Latvia
Spain
Bulgaria
France
Norway
Lithuania
Poland
EU/EEA
Czech Republic
Austria
Portugal
Ireland
Italy
Netherlands
Denmark
United Kingdom
Finland
0 5 10 15 20 25 30 35 40
Percentage
Note: countries that did not report AIDS (Belgium, Germany and Sweden) or reported no cases of TB as an AIDS-defining illness (Croatia, Cyprus, Estonia, Greece,
Hungary, Iceland, Ireland, Luxembourg, Norway, Slovakia and Slovenia) are excluded.
blood donations. The number of tests increased by progress in reducing the number of new HIV diagnoses
12% in countries reporting consistently since 2008 in the EU/EEA overall, rates continue to increase in about
(Table 26). Changes in overall testing activity do not one third of EU/EEA countries.
appear to explain the decrease in cases reported, par-
ticularly among MSM, in some European countries. It is There appears to be evidence of a true decrease in HIV
important to note that numbers provided are collected diagnoses among MSM in select EU/EEA countries that
in a heterogeneous manner and comparison between seems to be driving the overall decline observed in the
country rates should be undertaken with caution, but EU/EEA. This is significant because MSM still account for
the numbers can provide an indication of large changes the largest number of new HIV diagnoses in the EU/EEA;
in overall testing policy or provision to support the inter- until recently, this was the only population in the EU/EEA
pretation of HIV cases notified. in which HIV cases were increasing during most of the
last decade. The decline at EU/EEA level is driven by sub-
33
HIV/AIDS surveillance in Europe 2018 – 2017 data SURVEILLANCE REPORT
The positive trend described above is countered, benefits for the person diagnosed, early diagnosis and
however, by the prevailing situation in other EU/EEA treatment can also benefit sexual and injecting partners
countries where HIV continues to increase among MSM. by inhibiting onward HIV transmission. Nearly half of
Substantial increases have been reported in Bulgaria, those diagnosed (49%) have a CD4 cell count of below
Cyprus, Ireland, Malta, Poland and Romania in recent 350 cells per mm3 at diagnosis, including 28% of cases
years. Overall in the EU/EEA and even in some settings with advanced HIV infection (CD4 < 200 cells/mm3),
with declines in rates among MSM, new HIV diagnoses indicating the need to improve testing programmes to
in migrant MSM have not declined at the same rate as diagnose people living with HIV at an earlier stage. This
those who are not foreign-born. There is an urgent need is a clear indication that they were infected many years
for significant scaling up of more effective combination- previously and suggests problems with access to, and
prevention programmes for this at-risk population. This uptake of, HIV testing for those most at risk in these
includes promoting the uptake of regular, easy-to-access countries.
HIV testing, accompanied by immediate linkage to care
and treatment for those found positive, and condoms, One of the subgroups to emerge with the highest rate
peer support and possible PrEP for some populations of of late diagnosis is older adults (people aged over
high-risk HIV-negative men (4). 50 years), particularly older men reported as hav-
ing acquired HIV heterosexually. The trend during the
The substantial decrease in the number of HIV infections last decade has been towards increasing median age
transmitted through heterosexual contact, particularly at HIV diagnosis, particularly among women. In 2017,
among women, represents an important epidemiologi- nearly one in five new HIV diagnoses was of a person
cal trend observed over the past decade. Heterosexual over 50 years. This may be the result of stigma, or low
transmission nevertheless remains the second most or inaccurate risk perception among older adults or the
common mode of HIV transmission reported in the health-care providers who serve them (17).
EU/EEA and is the most common transmission mode
in some countries. Part of the declining trend in het- To address the high proportion of people diagnosed late,
erosexual cases is probably influenced by the decline it is essential to diversify HIV testing through augment-
(since 2008) in the number of heterosexually acquired ing routine testing for health conditions associated with
cases in migrants originating from countries with gener- HIV (indicator condition-guided testing), increasing HIV
alized HIV epidemics (5). Migrants (or people originating testing during screening for other sexually transmitted
from outside of the reporting country) again constituted infections, and continuing to expand community-based
a considerable proportion (41%) of new HIV diagno- testing, self-testing/home-sampling and partner noti-
ses in the EU/EEA in 2017. It is important to recognize fication. New European guidance on setting-based
the emerging evidence that a significant proportion of approaches for HIV and viral hepatitis testing, including
migrants, even those originating from high HIV-endemic best practices for effective implementation, can help
areas, acquire HIV after arrival in the EU/EEA (6–8). This countries seeking to implement more effective testing
indicates the need for targeted prevention directed at programmes (18). Testing provides not only a gateway to
this vulnerable group from the moment of their arrival. HIV treatment for people found to be positive, but can
Despite the overall declines, heterosexual transmission also serve as an entry point for high-risk HIV-negative
increased substantially in Estonia and Lithuania. people to effective prevention, including PrEP.
Transmission among people who inject drugs con- Despite clear evidence of the benefits of introducing
tinues to decline and remains at a low level in most ART early for the health of HIV-positive people (19,20)
EU/EEA countries, thanks to well-established harm- and the fact that this should serve as an incentive for
reduction programmes throughout most of the Region, people to know their HIV status, many continue to be
but sudden increases have been observed since 2016 diagnosed with HIV years after becoming infected and
in Lithuania. Outbreaks have been observed in recent having reached an advanced stage of illness. Overall,
years in Romania and Greece — countries with previ- 89% of AIDS diagnoses were made within 90 days of the
ously very low levels of HIV among people who inject HIV diagnosis, indicating that most AIDS cases in the
drugs (9,10) — and, more recently, localized outbreaks EU/EEA are due to late diagnosis of HIV infection. The
have been reported in Ireland, Luxembourg and United only group where half of AIDS cases occurred after the
Kingdom (Scotland) (11–13). This reinforces the impor- immediate HIV diagnosis was among people whose HIV
tance of maintaining adequate scale and coverage of infection was attributed to injecting drug use, possibly
harm-reduction services and recognizing that trends can indicating that AIDS diagnoses in this group are associ-
change quickly in this at-risk group in the absence of ated with lack of engagement with effective ART.
effective prevention delivered at scale (14).
Once tested, rapid linkage to high-quality care (includ-
It is estimated that 120 000 people were living with ing ART) is essential. Ninety-two per cent of people
undiagnosed HIV in the EU/EEA in 2015, implying that diagnosed in 2017 who had evidence of linkage to care
about 15% of those living with HIV are not aware of their were linked to care within three months of HIV diag-
status (15). Estimates also indicate that it takes 2.9 nosis. Timely linkage to care following HIV diagnosis
years from HIV infection to diagnosis in the EU/EEA, with is crucial, as delayed access can result in poor patient
variation by geographical area within the EU from 2.2 to outcomes (21). Once linked to care, there is evidence
3.6 years (16). In addition to the clinical and personal that high proportions of people diagnosed with HIV in
34
SURVEILLANCE REPORT HIV/AIDS surveillance in Europe 2018 – 2017 data
the EU/EEA have access to ART and achieve viral sup- 3. Evidence brief: pre-exposure prophylaxis for HIV prevention in
Europe. Stockholm: ECDC; 2016 (https://ecdc.europa.eu/sites/por-
pression (22). tal/files/media/en/publications/Publications/pre-exposure-proph-
ylaxis-hiv-prevention-europe.pdf).
Recent years have seen a worrying trend of reduced 4. HIV and STI prevention among men who have sex with men. ECDC
guidance. Stockholm: ECDC; 2014 (http://ecdc.europa.eu/en/pub-
data completeness on the HIV transmission route, with lications/Publications/hiv-sti-prevention-among-men-who-have-
about one quarter of cases reported in 2017 lacking this sex-with-men-guidance.pdf).
5. Hernando V, Alvarez-del Arco D, Alejos B, Monge S, Amato-Gauci AJ,
important information. While this proportion may have Noori T et al. HIV infection in migrant populations in the European
been affected by the earlier reporting deadline and by Union and European Economic Area in 2007–2012: an epidemic on
the move. J Acquir Immune Defic Syndr. 2016;70(2):204–11.
reporting changes in several countries that have tempo-
6. Rice BD, Elford J, Yin Z, Delpech VC. A new method to assign country
rarily affected data completeness, the trend has been of HIV infection among heterosexuals born abroad and diagnosed
evident in recent years. Information on probable route with HIV. AIDS 2012;26(15):1961–6.
7. Fakoya I, Alvarez-del Arco D, Woode-Owusu M, Monge S, Rivero-
of transmission is crucial to better inform HIV prevention Montesdeoca Y, Delpech V et al. A systematic review of post-
interventions and programme planning. Greater efforts migration acquisition of HIV among migrants from countries with
generalised HIV epidemics living in Europe: implications for effec-
to improve collaboration with clinicians and follow up tively managing HIV prevention programmes and policy. BMC Public
with other data providers may improve the transmission Health 2016;15:561 (http://www.biomedcentral.com/content/pdf/
s12889-015-1852-9.pdf).
data. Meanwhile, statistical adjustments for missing 8. Fakoya I, Alvarez-Del Arco D, Monge S, Copas AJ, Gennotte A-F et
data are being explored (23). al. HIV testing history and access to treatment among migrants
living with HIV in Europe. J Int AIDS Soc. 2018;21(Suppl. 4):e25123
(https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.25123).
The changing epidemiology of HIV infections observed
9. Hedrich D, Kalamara E, Sfetcu O, Pharris A, Noor A, Wiessing
in the EU/EEA over the last decade suggests that some L et al. Human immunodeficiency virus among people who
inject drugs: is risk increasing in Europe? Euro Surveill.
progress has been achieved, particularly on reducing 2013;18(48):pii=20648 (http://www.eurosurveillance.org/
infections attributed to heterosexual transmission and ViewArticle.aspx?ArticleId=20648).
injecting drug use and, more recently, the decline of 10. Paraskevis D, Nikolopoulos G, Tsiara C, Paraskeva D, Antoniadou
A, Lazanas M et al. HIV-1 outbreak among injecting drug
HIV resulting from sex between men in some EU/EEA users in Greece, 2011: a preliminary report. Euro Surveill.
countries. These epidemiological trends also indicate, 2011;16(36):pii=19962 (http://www.eurosurveillance.org/
ViewArticle.aspx?ArticleId=19962).
however, that it is crucial to sustain, and in some places 11. Giese C, Igoe D, Gibbons Z, Hurley C, Stokes S, McNamara S et
strengthen, evidence-based HIV prevention interven- al. Injection of new psychoactive substance snow blow asso-
ciated with recently acquired HIV infections among homeless
tions tailored to the local epidemiological context and people who inject drugs in Dublin, Ireland, 2016. Euro Surveill.
targeting those most at risk. 2016;20(40):pii=30036. doi:http://dx.doi.org/10.2807/1560-7917.
ES.2016.20.40.30036.
12. Public Health England, Health Protection Scotland, Public Health
Programmes on the prevention and control of HIV infec- Wales, Public Health Agency Northern Ireland. Shooting up: infec-
tion adapted to key populations and maintained to scale tions among people who inject drugs in the UK, 2016. London:
Public Health England; 2017 (https://www.gov.uk/government/
remain important in EU/EEA countries. For most EU/EEA uploads/system/uploads/attachment_data/file/567231/Shooting_
countries, this means a strong focus on MSM, including Up_2017_Update.pdf).
13. HIV in people who inject drugs – joint technical mission to
intra-European and other migrant MSM. Other migrants, Luxembourg. Stockholm, Lisbon: ECDC/European Monitoring Centre
both those from countries with generalized HIV epidem- for Drugs and Drug Addiction; 2018 (http://sante.public.lu/fr/
publications/h/hiv-joint-technical-mission/index.html).
ics and others, are also a key vulnerable population
14. ECDC, European Monitoring Centre for Drugs and Drug Addiction.
that needs specific prevention and control efforts in Prevention of infections among people who inject drugs.
most EU/EEA countries. Given the increasing evidence Stockholm: ECDC; 2011 (http://ecdc.europa.eu/en/publications/
Publications/111012_Guidance_Infectious_diseases_IDU_brief.
of post-migration HIV acquisition, it is important that pdf).
migrant-sensitive services for prevention and HIV test- 15. Pharris A, Quinten C, Noori T, Amato-Gauci AJ, van Sighem A, the
ECDC HIV/AIDS Surveillance and Dublin Declaration Monitoring
ing, combined with policies that promote and ensure Networks. Estimating HIV incidence and number of undiagnosed
linkage and access to care, are delivered in all EU/EEA individuals living with HIV in the European Union/European
Economic Area, 2015. Euro Surveill. 2016;21(48):pii=30417
countries. (http://www.eurosur veillance.org/content/10.2807/1560-7917.
ES.2016.21.48.30417).
Harm-reduction programmes among people who inject 16. van Sighem A, Pharris A, Quinten C, Noori T, Amato-Gauci AJ, the
ECDC HIV/AIDS Surveillance and Dublin Declaration Monitoring
drugs and their sexual partners are crucial and should Networks. Reduction in undiagnosed HIV infection in the
be maintained and scaled up where service coverage European Union/European Economic Area, 2012 to 2016. Euro
Surveill. 2017;22(48):pii=17-00771 (https://doi.org/10.2807/1560-
is low, particularly when patterns of drug use change. 7917.ES.2017.22.48.17-00771).
Finally, strengthening the offer and effectiveness of HIV 17. Tavoschi L, Gomes Dias J, Pharris A, on behalf of the HIV Surveillance
Network. New HIV diagnoses among adults aged 50 years or older in
testing programmes to increase the frequency of testing 31 European countries, 2004–15: an analysis of surveillance data.
in high-risk individuals will help to decrease late diagno- Lancet HIV 2017;4(11):e514–21.
sis and, ultimately, the proportion of people living with 18. INSIGHT START Study Group. Initiation of antiretroviral
therapy in early asymptomatic HIV infection. N Engl J Med.
undiagnosed HIV in the EU/EEA. 2016:373(9):795–807.
19. Consolidated guidelines on the use of antiretroviral drugs
for treating and preventing HIV infection. Recommendations
References for a public health approach. Second edition. Geneva: World
1. Brown AE, Mohammed H, Ogaz D, Kirwan PD, Yung M, Nash SG et Health Organization; 2017 (http://apps.who.int/iris/bitstr
al. Fall in new HIV diagnoses among men who have sex with men eam/10665/208825/1/9789241549684_eng.pdf?ua=1).
(MSM) at selected London sexual health clinics since early 2015: 20. Public health guidance on HIV, hepatitis B and C testing in the EU/
testing or treatment or pre-exposure prophylaxis (PrEP)? Euro EEA. Stockholm: ECDC; 2018 (https://ecdc.europa.eu/sites/por-
Surveill. 2017;22(25):pii=30553 (http://www.eurosurveillance.org/ tal/files/documents/HIV-hepatitis-B-and-C-testing-public-health-
content/10.2807/1560-7917.ES.2017.22.25.30553). guidance.pdf).
2. Nwokolo N, Whitlock G, MacOwan A. Not just PrEP: other reasons 21. Croxford S, Yin Z, Burns F, Copas A, Town K, Desai S et al.
for London’s HIV decline. Lancet HIV 2017;4(4):e153 (http://www. Linkage to HIV care following diagnosis in the WHO European
thelancet.com/journals/lanhiv/article/PIIS2352-3018(17)30044-9/ Region: a systematic review and meta-analysis, 2006–2017.
fulltext).
35
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PLoS One 2018;13(2):e0192403 (https://doi.org/10.1371/journal. 23. Rosinska M, Pantazis N, Janiec J, Pharris A, Amato-Gauci AJ, Quinten
pone.0192403). C et al. Potential adjustment methodology for missing data and
22. Monitoring implementation of the Dublin Declaration on Partnership reporting delay in the HIV Surveillance System, European Union/
to fight HIV/AIDS in Europe and central Asia: thematic report on the European Economic Area, 2015. Euro Surveill. 2018;23(23):pii=170
HIV continuum of care. Stockholm: ECDC; in press. 0359 (https://doi.org/10.2807/1560-7917.ES.2018.23.23.1700359).
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SURVEILLANCE REPORT HIV/AIDS surveillance in Europe 2018 – 2017 data
37
HIV/AIDS surveillance in Europe 2018 – 2017 data SURVEILLANCE REPORT
Fig. 2.1. Age- and gender-specific rates of new HIV diagnoses per 100 000 population, WHO European Region, 2017
(n = 54 828)
30 Women
New HIV diagnoses per 100 000 population
Men
25
20
15
10
0
< 15 15–19 20–24 25–29 30–39 40–49 50+
Age category (years)
• Injecting drug use accounted for 13% of new diag- Forty countries provided information about CD4 cell
noses (7147) and 15% of new HIV diagnoses with a count at the time of HIV diagnosis in 2017. Information
known mode of transmission (Table 5). was reported for 36 441 people over 14 years at diag-
nosis (covering 66% of all new diagnoses and 77% of
• One per cent (0.7%, 397) was infected through
diagnoses in the 40 reporting countries) (Table 14).
mother-to-child transmission (0.9% of those with
Just over half (53%) of people newly diagnosed were
a known mode of transmission) (Table 7) and 0.2%
late presenters, with CD4 cell counts below 350 per
(105) through other transmission routes (nosocomial
mm3 blood at the time of HIV diagnosis, including 32%
infection, transfusion or use of other blood products)
with advanced HIV infection (CD4 < 200/mm3). Twenty
(Table 8).
per cent had a CD4 cell count of between 350 and 500
• Transmission mode was reported as unknown or cells per mm3 and 29% had a count above 500 per mm3
missing for 15% (8492 cases) (Table 8). Reporting (data not shown). The percentage of people newly diag-
completeness regarding mode of transmission mode nosed who were late presenters (CD4 < 350/mm3) varied
varies greatly across the Region, with information across the Region and was highest in the East (57%),
lacking for 3% of new diagnoses in the East, 41% in lower in the Centre (53%) and lowest in the West (48%).
the Centre and 23% in the West. The countries with the highest percentages of late pre-
senters (≥ 60%, in countries with more than five cases)
When combining data from the Russian Federation (see were Kyrgyzstan (68%), Lithuania (66%), Serbia (66%),
“HIV diagnoses in the East” below) within data reported Tajikistan (63%), Latvia (62%), Montenegro (62%) and
by the other 49 countries for the WHO European Region, Romania (60%), and those with the lowest percent-
heterosexual transmission accounted for 56% of new ages (< 45%) were the Czech Republic (33%), the former
diagnoses among people for whom the mode of HIV Yugoslav Republic of Macedonia (38%), Cyprus (41%),
transmission was known, transmission through injecting the United Kingdom (41%) and Belgium (42%).
drug use 30%, sex between men 14% and mother-to-
child transmission 0.6%. The percentage of late presenters was higher than the
regional average of 53% in 15 countries (seven in the
Information about country of birth, country of national- East, five in the Centre and three in the West). The per-
ity or region of origin was provided by 46 countries for centage also varied across transmission categories and
54 791 people newly diagnosed in 2017. Among people was highest for people with reported heterosexual trans-
with known origin (50 677), 19% (9753) originated from mission (58%, 62% for men and 54% for women) and
outside of the reporting country, including 14% (7032) through injecting drug use (55%), and lowest for men
from outside the WHO European Region and 5% (2721) infected through sex with men (39%) (Table 14, Fig. 2.2,
from a European country other than the country of report Fig. C). The percentage of people diagnosed at or below
(Table 11). 350 CD4 cells per mm3 increased with age, ranging from
34% and 32% among people aged 15–19 and 20–24
Information about probable country of infection was
years at diagnosis, respectively, to 66% among people
reported by 37 countries for 30 201 people newly diag-
aged 50 or above. By gender, overall, the percentage of
nosed. Among people for whom the probable country of
late presenters was similar (52% for men and 54% for
infection was known (19 599), 19% (3654) were infected
women), which is confounded by transmission mode and
abroad, including 6% in sub-Saharan Africa, 5% in
conceals, for men, the difference between MSM (who
central and eastern Europe, 3% in western Europe, 3%
tend to get diagnosed earlier) and men with reported
in south and south-east Asia and 2% in Latin America
(Table 13).
38
SURVEILLANCE REPORT HIV/AIDS surveillance in Europe 2018 – 2017 data
Fig. 2.2. New HIV diagnoses, by CD4 cell count per mm3 at diagnosis and transmission mode, WHO European Region,
2017 (n = 33 840)
< 200 cells/mm3
Heterosexual n = 20 638
transmission
0 20 40 60 80 100
Percentage
Note: no data from Andorra, Belarus, Germany, Hungary, Iceland, Latvia, Monaco, Norway, Poland, Russian Federation, San Marino, Turkey, Turkmenistan and
Uzbekistan.
heterosexual transmission (who tend to get diagnosed Turkmenistan and Uzbekistan were not consistently
later) (Fig. C). reported during the period. Data on transmission mode
from the countries with consistent data indicate that:
Trends in HIV diagnoses
• the number of new diagnoses in people with reported
The rate of newly diagnosed HIV infections in the WHO heterosexual transmission increased by 13% in the
European Region19 increased by 37% for the period Region, from 21 094 in 2008 to 23 735 in 2017, while
2008–2017, from 14.6 per 100 000 population (107 385 the percentage of all new HIV diagnoses attributed to
cases) to 20.0 per 100 000 population (159 420 cases) heterosexual contact increased from 47% of cases in
(Fig. 2.3a). The increase is mainly driven by an upward 2008 to 54% in 2017;
trend in the East, where the rate increased by 68%,
• the number of new diagnoses in people infected
from 30.4 in 2008 (77 228 cases) to 51.1 in 2017 (130 861
through sex between men decreased by 2%, from
cases).
7945 in 2008 to 7779 in 2017, and the percentage of
In the 49 countries that reported to ECDC and WHO,13 all new HIV diagnoses attributed to sex between men
the regional rate decreased by a slight 5%, from 8.8 in remained stable at 18%;
2008 (52 435 cases) to 8.4 in 2017 (55 018 cases) (not • the number of new diagnoses in people infected
adjusted for reporting delay20) (Fig. 2.3b): in the East, the through injecting drug use decreased by 38%, from
rate increased by 18%, from 20.0 (22 278 cases) to 23.6 11 034 in 2008 to 6893 in 2017, while the percentage
(26 459 cases); in the Centre, by 129% – the largest rela- of all HIV diagnoses attributed to injecting drug use
tive increase across the three geographical areas – from decreased from 25% in 2008 to 16% in 2017;
1.4 (2627 cases) to 3.2 (6205 cases); and in the West, the
rate decreased by 27%, from 9.4 (27 530 cases) to 6.9 • the number of new diagnoses in children infected
(23 976 cases, adjusted for reporting delay21). through mother-to-child transmission decreased by
47%, from 673 in 2008 to 360 in 2017, representing
Forty-four countries have consistently reported data 1.4% of all new HIV diagnoses in 2008 and 0.8% in
on transmission mode for the period 2008–2017 2017;
(Fig. 2.4). Data from Estonia, Poland and Turkey were
• of the new diagnoses in people infected by other
excluded because more than 50% of the data on trans-
means, nosocomial infections decreased by 76% from
mission mode were missing for the period; data from
a peak of 98 cases in 2008, which was related to a
Spain and Italy were excluded because coverage of the
localized outbreak in central Asia, to 24 in 2017 (with
national surveillance system increased over this time
another peak of 104 cases in 2012); new diagnoses
period; and data from Germany, the Russian Federation,
attributed to transfusion of blood and its products
19 No data were received from Turkmenistan and Uzbekistan; data
decreased by 34%, from 87 in 2008 to 57 in 2017; and
from the Russian Federation were derived from the Russian Federal
Scientific and Methodological Centre for Prevention and Control of • the number of new diagnoses for which information
AIDS (1–3). about transmission mode was unknown or missing
20 When adjusting the 2017 regional rate for reporting delay, the trend increased by 39%, from 3672 in 2008 to 5086 in 2017
for the decade remains stable at 8.8 in 2008 and 8.7 in 2017; see
Annex 1 for methods and Annex 6 for results. – representing 8% of all new HIV diagnoses in 2008
21 See Annex 1 for methods and Annex 6 for results (see also “HIV and and 12% in 2017.
AIDS diagnoses in the West” below and Fig. 2.3b).
39
HIV/AIDS surveillance in Europe 2018 – 2017 data SURVEILLANCE REPORT
Fig. 2.3a. New HIV diagnoses per 100 000 population, by year of diagnosis, WHO European Region,a 2008–2017
60 West
New HIV diagnoses per 100 000 population
Centre
50
East
WHO European Region
40
30
20
10
0
2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
Year of diagnosis
a
I n 50 countries (data from Germany, Turkmenistan and Uzbekistan excluded due to inconsistent reporting during the period), data from the Russian Federal
Scientific and Methodological Centre for Prevention and Control of AIDS (1–3).
Fig. 2.3b. Rate of new HIV diagnoses, by year of diagnosis, WHO European Region,a 2008–2017
25 West
New HIV diagnoses per 100 000 population
Centre
20 East
WHO European Region
15
10
0
2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
Year of diagnosis
a
In 49 reporting countries (no data from Russian Federation, and data from Germany, Turkmenistan and Uzbekistan excluded due to inconsistent reporting during the
period).
AIDS cases, morbidity and mortality lowest rates (< 0.3) reported in Bosnia and Herzegovina
(0.1), the former Yugoslav Republic of Macedonia (0.1),
In 2017, 14 703 people in 47 countries of the WHO Turkey (0.1)23 and Slovakia (0.2). Andorra, Iceland, Malta,
European Region22 were diagnosed with AIDS, which Monaco and San Marino reported zero cases.
corresponds to a rate of 2.3 per 100 000 population
(Table 15). Of the 14 703 people who had an AIDS diag- Twenty per cent of people diagnosed with AIDS pre-
nosis in 2017, 78% (11 454) were diagnosed in the East, sented with TB as an AIDS-defining illness, ranging from
17% (2426) in the West and 6% (823) in the Centre of the 15% of cases in the West and 19% in the Centre to 26%
Region. The rate was also highest in the East (10.2 per in the East.
100 000 population), more than 10 times higher than
in the West (0.7 per 100 000) and more than 20 times The overall rate of new AIDS diagnoses in the Region
higher than in the Centre (0.4 per 100 000 population). increased between 2008 and 2017 by 10%, from 2.1 per
100 000 population (13 328 cases) to 2.3 per 100 000
At country level, the rate of new AIDS diagnoses varied (14 703 cases), in the 47 countries with consistent AIDS
widely, with the highest rates (≥ 3.0) reported in Ukraine
(21.9), the Republic of Moldova (6.9), Georgia (6.6),
Latvia (6.0), Armenia (4.9) and Belarus (4.6), and the
23 AIDS data for Turkey only include people diagnosed with AIDS at the
22 No data were available from Belgium, Germany, the Russian time of HIV diagnosis and are therefore not comparable with AIDS
Federation, Sweden, Turkmenistan or Uzbekistan. data from other countries.
40
SURVEILLANCE REPORT HIV/AIDS surveillance in Europe 2018 – 2017 data
data24 (Fig. 2.5). Since there are reporting delays in some 47 countries in the WHO European Region25 and included
countries, this decrease is expected to even out over the 4933 people who were reported to have died during
coming years. 2017. This represented a 14% decrease compared with
the 5718 deaths reported in the same countries in 2008.
AIDS trends varied greatly across the three geographi- Of the 4933 deaths in 2017, 84% were reported from the
cal areas. In the East, the rate doubled, from 5.1 in 2008 East of the Region, 11% from the West and 5% from the
to 10.2 in 2017. In the Centre, the rate remained stable Centre (Table 24). It is important to note that delays in
at 0.4 per 100 000 population, while in the West, the reporting and underreporting have a significant impact
steady downward trend continued, with a 67% decrease on these numbers at European level, particularly when
from 2.1 in 2008 to 0.7 in 2017 (Fig. 2.5). the death occurs long after HIV or AIDS diagnosis. The
numbers presented here should therefore not be inter-
Information about AIDS-related deaths, or deaths among
preted as being representative of the true AIDS mortality
people previously diagnosed with AIDS for countries and
burden in the European Region. According to a country
years where cause of death (AIDS or non-AIDS related)
survey from 2006, only about one third of countries
was unknown or could not be reported, was provided by
in the WHO European Region were able to match their
24 Data from Belgium, Germany, the Russian Federation, Sweden, 25 No data were received from Italy, the Russian Federation, Sweden,
Turkmenistan and Uzbekistan are excluded or not available. Turkmenistan and Uzbekistan.
Fig. 2.4. New HIV diagnoses, by transmission mode and year of diagnosis, WHO European Region, 2008–2017
10 000
5000
0
2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
Year of diagnosis
Note: data from Russian Federation, Turkmenistan and Uzbekistan excluded due to inconsistent reporting during the period; data from Estonia, Poland and Turkey
excluded due to incomplete reporting on transmission mode during the period; data from Italy and Spain excluded due to increasing coverage of national surveillance
during the period.
Fig. 2.5. AIDS diagnoses per 100 000 population, by geographical area and year of diagnosis, WHO European Region,
2008–2017
12 West
AIDS diagnoses per 100 000 population
Centre
10
East
WHO European Region
8
0
2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
Year of diagnosis
Note: data from Belgium, Russian Federation, Sweden, Turkmenistan and Uzbekistan excluded due to inconsistent reporting during the period.
41
HIV/AIDS surveillance in Europe 2018 – 2017 data SURVEILLANCE REPORT
HIV/ AIDS registries with their national mortality or vital to WHO/ECDC, among people for whom the mode of HIV
statistics registries (4). transmission was known, heterosexual sex accounted
for 59% of new diagnoses, transmission through inject-
HIV and AIDS diagnoses in the ing drug use for 37%, sex between men for 3% and
mother-to-child transmission for 0.5% of new diagnoses
East in 2017.
HIV diagnoses in the East In the 12 reporting countries alone, 2017 data by mode of
In 2017, 130 861 people were newly diagnosed with HIV transmission suggest the following (Table A, Tables 4–8,
across 13 countries26 in the East of the WHO European Fig. 2.7).
Region, giving a rate of 51.1 per 100 000 population. This • Sixty-eight per cent of those newly diagnosed and
number includes 26 459 new diagnoses reported to the 70% of new HIV diagnoses with a known mode of
joint WHO/ECDC surveillance system by 12 countries27 transmission were infected heterosexually (17 882),
and 104 402 cases from the Russian Federation (1), con- making it the main reported transmission mode in
tinuing the alarming trend of previous years by once all East countries except Lithuania, where the num-
again being the highest number and rate ever observed ber of people infected through injecting drug use
in the East – a slight 2% increase compared with the rate has tripled in just two years and become the leading
of 50.2 reported for 2016 in the 2017 HIV surveillance in mode of HIV transmission, primarily due to injecting
Europe report (5). For the 12 countries that reported to drug use-related transmission in prison settings or
WHO/ECDC, the rate was 23.6 per 100 000 population. among former inmates with a history of drug injection
(Table 6).
At country level, the highest rates (> 20.0) for 2017 were
observed in the Russian Federation (71.1 per 100 000 • Twenty-four per cent of those newly diagnosed and
population) (1), Ukraine (37.0),28 Belarus (26.1) and the 25% of new HIV diagnoses with a known mode of
Republic of Moldova (20.6), while the lowest (< 10.0) transmission were infected through injecting drug
reported by Azerbaijan (5.8) and Lithuania (9.1). use (6375) (Table 5). Transmission through injecting
drug use accounted for 20% or more of new diagnoses
In the 12 East countries that reported to WHO/ECDC, with a known transmission mode in eight countries
most people newly diagnosed (40%) were in the age (Lithuania (62%), Latvia (33%), Kazakhstan (31%),
group 30–39 years, while only 7% were young people Kyrgyzstan (27%), Ukraine (25%), Georgia (24%),
aged 15–24 years; 13% were 50 years or older at the time Tajikistan (22%) and Belarus (20%)).
of diagnosis (Table A, Table 9). The male-to-female ratio
was 1.6, the lowest of the three geographical areas, cor- • Four per cent were infected through sex between men
responding to 39% of new diagnoses being in women in (1036) (Table 4), but three countries (Estonia, Georgia
the East in 2017. The male-to-female ratio was highest and Latvia) reported that sex between men accounted
(> 2.0) in Lithuania (5.1), Georgia (3.5) and Armenia (2.5), for 10% or more of new diagnoses with a known trans-
and lowest (< 1.5) in the Republic of Moldova (1.3) and mission mode.
Kyrgyzstan (1.4) (Fig. 2.6). Among people infected with • One per cent (0.9%) was infected through mother-
reported heterosexual transmission, the male-to-female to-child transmission (242) (Table 7) and 0.1% (21)
ratio was ≥ 1.5 in three countries (Armenia (2.0), Georgia through other transmission routes (nosocomial infec-
(1.6) and Lithuania (1.5)), suggesting that more men than tion, transfusion or use of other blood products).
women were reported as infected through heterosexual
contact in these countries. As this pattern differs from • Transmission mode was reported as unknown or miss-
other countries where more heterosexual cases tend to ing for only 3% of those newly diagnosed across the
be in women, it cannot be excluded that some of these 12 East countries (903), but at country level, transmis-
men may in fact have been infected through injecting sion mode information was lacking for more than 15%
drug use or sex with other men, but were misclassified of cases in five countries: Estonia (46%), Latvia (36%),
into the heterosexual category. the Republic of Moldova (23%), Azerbaijan (18%) and
Lithuania (16%).
Heterosexual contact and injecting drug use remain the
main reported modes of HIV transmission in the East Analysing the new diagnoses by age group and trans-
of the Region. Reported transmission related to sex mission mode for the 12 reporting countries in the East
between men remains low, although it is increasing. (Fig. 2.8) shows that 30–39-year-olds accounted for
most HIV diagnoses across all transmission groups (50%
When combining data for the Russian Federation within of people infected through injecting drug use, 38% with
data reported by the 12 East countries that provided data reported heterosexual transmission and 35% through
sex between men). People in the younger age groups
26 No data were received from Turkmenistan and Uzbekistan. tended to be infected through sex between men: among
27 No data were received from the Russian Federation, Turkmenistan MSM, 48% of adults (aged 15–49) were under 30 years at
and Uzbekistan.
diagnosis compared with only 14% and 21% among those
28 Without taking into account data from Crimea, Sevastopol city and
parts of the non-government controlled areas of Ukraine; adjusting infected through injecting drug use and heterosexual
population denominator data to exclude Crimea and Sevastopol city; sex, respectively. People aged 50 years and above were
and excluding infants born to HIV-positive mothers whose HIV status
is undetermined. more frequently infected through heterosexual sex (16%
42
SURVEILLANCE REPORT HIV/AIDS surveillance in Europe 2018 – 2017 data
Fig. 2.6. Male-to-female ratio in all new HIV diagnoses and new diagnoses with heterosexual transmission, by country,
East, 2017 (n = 26 459; 5751)
Armenia 2.47
1.96
Estonia 2
1.17
1.85
Latvia 1.22
1.66
Belarus 1.34
Azerbaijan 1.73
Tajikistan 1.57
1.04
East average 2
1.01
Ukraine 1.48
0.95
Kazakhstan 1.53
0.88
Republic 1.31
of Moldova 1.07
Kyrgyzstan 1.41
0.78
0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0 4.5 5.0
Male-to-female ratio
Note: no data were received from the Russian Federation, Turkmenistan and Uzbekistan.
Fig. 2.7. New HIV diagnoses, by country and transmission mode, East, 2017 (n = 26 459)
Sex between men
Armenia
Heterosexual transmission
Ukraine Other
Unkown
Republic
of Moldova
Tajikistan
Kazakhstan
Azerbaijan
Kyrgyzstan
Georgia
Estonia
Latvia
Lithuania
0 20 40 60 80 100
Percentage
Note: no data were received from the Russian Federation, Turkmenistan and Uzbekistan.
43
HIV/AIDS surveillance in Europe 2018 – 2017 data SURVEILLANCE REPORT
compared with 7% and 5% for injecting drug use and countries. Among those for whom the probable source
MSM, respectively) (Fig. 2.8). of infection was known (which was only 1855 cases),
73% had a heterosexual partner from a non-generalized
Eleven countries in the East provided information about epidemic country (other than the reporting country) and
CD4 cell count at the time of HIV diagnosis for 19 472 24% had sexual contact with a person who injected
people above 14 years (covering 74% of the 26 459 new drugs. Although these data are scarce, they suggest
diagnoses reported by the 12 East countries and 81% ongoing heterosexual transmission outside the report-
of new diagnoses in the 11 countries with data on CD4 ing country and related to partners with a history of
cells (Table 14)). Fifty-seven per cent of these people injecting drug use.
were late presenters with CD4 cell counts below 350 per
mm3, including 35% with advanced HIV infection (CD4 Nine countries in the East provided information about
< 200/mm3) at the time of HIV diagnosis. The percent- the probable country of infection for 9571 people newly
age of people diagnosed with a CD4 count of less than diagnosed in 2017 (covering 36% of all new diagnoses
350/mm3 was higher than 50% in all 11 countries except reported by the 12 East countries) (Table 13). Among the
Kazakhstan (46%). The percentage of late presenters 8263 cases for whom the probable country of infection
varied across transmission categories; it was highest was known, only 8% (620 cases) were infected abroad,
for people infected heterosexually (59%) and through including 7% in central and eastern Europe. These data
injecting drug use (55%), and lowest for men infected suggest that most of those newly diagnosed with HIV
through sex with men (43%) (Fig. 2.9). in the East of the Region are infected in the reporting
country and that those infected abroad are infected in
Nine countries provided information on the probable neighbouring countries of central and eastern Europe.
source of infection for 6611 people with reported het-
erosexual transmission (Table 10), covering 37% of the
heterosexually acquired cases reported by the 12 East
Fig. 2.8. New HIV diagnoses, by age group and transmission mode, East, 2017 (n = 25 286)
15–19 years
Sex between men n = 6374
20–24 years
25–29 years
Transmission mode
30–39 years
Heterosexual n = 17 876 40–49 years
transmission
≥ 50 years
0 20 40 60 80 100
Percentage
Note: no data were received from the Russian Federation, Turkmenistan and Uzbekistan.
Fig. 2.9. New HIV diagnoses, by CD4 cell count per mm3 at diagnosis and transmission mode, East, 2017 (n = 19 254)
< 200 cells/mm3
Injecting drug use n = 851
200 to < 350 cells/mm3
350 to < 500 cells/mm3
Transmission mode
≥ 500 cells/mm3
Heterosexal n = 13 743
transmission
0 20 40 60 80 100
Percentage
Note: no data were received from from Belarus, Turkmenistan, Ukraine and Uzbekistan.
44
SURVEILLANCE REPORT HIV/AIDS surveillance in Europe 2018 – 2017 data
Trends in HIV diagnoses in the East modes and geographical areas. It is clearly visible
on the logarithmic scale of Fig. 2.10, which enables
The increasing trend in newly diagnosed HIV infections easier comparison of rates of change regardless of
continued in the East29 over the last decade, with a 68% starting point. The percentage of all new HIV diagno-
increase in the rate of new diagnoses per 100 000 popu- ses attributed to sex between men, while increasing,
lation, from 30.4 in 2008 (77 228 cases) to 51.1 in 2017 nevertheless remained low at 0.6% in 2008 and 4%
(130 861 cases) (Fig. 2.3a). in 2017.
In the 12 East countries that reported to WHO/ECDC, • The number of children infected through mother-to-
the rate increased by a more modest 18%, from 20.0 child transmission decreased by 30%, from 348 in
in 200830 (22 278 cases) to 23.6 in 2017 (26 459 cases) 2008 to 242 in 2017, representing 1.6% of new HIV
(Fig. 2.3b). The rate more than doubled between 2008 diagnoses in 2008 and 0.9% in 2017.
and 2017 in four countries (Armenia, Belarus, Lithuania
and Tajikistan), whereas the increase remained more • The number of new diagnoses for which the mode of
moderate (< 30% increase) in another five countries transmission was unknown increased by 22%, from
(Azerbaijan, Kazakhstan, Latvia, the Republic of 658 in 2008 to 803 in 2017. The percentage of new
Moldova and Ukraine). In Estonia, the only country that HIV diagnoses with unknown mode of transmission
has seen a sustained decrease in new diagnoses over remained low and stable at 3% in both 2008 and 2017.
the decade, the rate continued the steady decline that
When combining data from the Russian Federation (1,2)
began after the 2001 peak in new diagnoses and which
within data from the 11 reporting countries with con-
sustained through to 2017 (Table 1).
sistent data on mode of transmission in the East, the
The number of newly diagnosed women increased by percentage of new HIV diagnoses with reported het-
16% across the 12 countries, from 8913 in 2008 to 10 erosexual transmission, among those with a known
329 in 2017, and the number of newly diagnosed men transmission mode, increased from 42% in 2008 to 59%
increased by 23%, from 13 082 to 16 130 (Tables 2 and 3). in 2017, while the percentage acquired through injecting
drug use decreased from 55% in 2008 to 37% in 2017.
Information about mode of transmission for the period
2008–2017 (Fig. 2.10) from the 11 countries with consist- Further analysis of the increase in new diagnoses attrib-
ent data31 suggests the following. uted to heterosexual transmission in the East by gender
and age groups (Fig. 2.11, no data from the Russian
• The number of new diagnoses in people with reported Federation) reveals continuing increases in older age
heterosexual transmission increased by 69%, from groups for both men and women (it is highest in those
10 505 in 2008 to 17 793 in 2017. The increase was aged ≥ 50 years, followed by the 40–49 and 30–39 age
considerably larger among men with heterosexual groups). Heterosexual transmission has nevertheless
transmission (a 107% increase) than women with het- continued to decrease among young women of 15–24
erosexual transmission (21% increase). At the same and 25–29 years, by 59% and 36%, respectively. The
time, the percentage of all new HIV diagnoses attrib- number of new diagnoses among all men with reported
uted to heterosexual contact increased from 48% of heterosexual transmission doubled over the decade,
cases in 2008 to 68% in 2017. while it increased only by 21% among women.
• The number of new diagnoses in people infected
through injecting drug use decreased by 36%, from
AIDS cases, morbidity and mortality in the East
10 006 in 2008 to 6361 in 2017, but the number tripled In 2017, 11 454 people were diagnosed with AIDS from
in just three years in Lithuania and more than doubled the 12 countries in the East that provided AIDS data,
over the decade in Belarus, despite a small decline giving a rate of 10.2 per 100 000 population. The high-
in 2016–2017 that followed a peak in 2015 (Table 5). est rates (> 5.0) were reported in Ukraine (21.9), the
The percentage of all new HIV diagnoses attributed Republic of Moldova (6.9), Georgia (6.6) and Latvia (6.0)
to injecting drug use decreased from 46% in 2008 to (Table 15).
24% in 2017.
The AIDS rate doubled between 2008 and 2017, from
• The number of new diagnoses in people infected 5.1 per 100 000 population (5685 cases) to 10.2 (11 454
through sex between men increased eight-fold, from cases) in the 12 countries (Fig. 2.5). The rate of new AIDS
126 in 2008 to 1020 in 2017. This is by far the high- diagnoses increased in all countries in the East except
est relative increase across the various transmission Estonia, most noticeably in Tajikistan and the Republic
of Moldova, where the rate tripled, and in Azerbaijan and
29 No data were received from Turkmenistan and Uzbekistan; data
Ukraine, where it more than doubled. By mode of trans-
from the Russian Federation were derived from the Russian Federal mission, both in men infected through sex between men
Scientific and Methodological Centre for Prevention and Control of
AIDS (1–3). and in people infected heterosexually, the rate of new
30 The drop in new diagnoses starting from 2014–2015 (Fig. 2.2b) is AIDS diagnoses increased four-fold between 2017 and
caused mainly by a decrease reported by Ukraine, which is partly 2008. AIDS cases in people infected through injecting
related to a lack of data from parts of Ukraine since then.
drug use remained stable in comparison with 2007 but
31 Data from the Russian Federation, Turkmenistan and Uzbekistan
are not included due to inconsistent reporting during the period; decreased by 40% in comparison with 2011 (Fig. 2.12).
data from Estonia were excluded due to incomplete reporting on
transmission mode during the period.
45
HIV/AIDS surveillance in Europe 2018 – 2017 data SURVEILLANCE REPORT
Fig. 2.10. New HIV diagnoses, by transmission mode and year of diagnosis, East, 2008–2017
Arithmetic scale
5000
0
2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
Year of diagnosis
Logarithmic scale
100
10
1
2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
Year of diagnosis
Note: data from the Russian Federation, Turkmenistan and Uzbekistan excluded due to inconsistent reporting during the period; data from Estonia excluded due to
incomplete reporting on transmission mode during the period.
The trend for more recent years, however, is that the AIDS-related mortality remains high in the East, with
AIDS rate has slowly been stabilizing and has even 4120 reported AIDS-related deaths or deaths among
declined by a slight 7% since 2012. people previously diagnosed with AIDS where cause of
death (AIDS or non-AIDS related) was unknown or could
The most common AIDS-indicative diseases diagnosed not be reported in the 12 countries for 2017, compris-
in 2017 were wasting syndrome due to HIV (17% of all ing 84% of all deaths reported in the Region. This is a
disease events reported), pulmonary TB (13%) and 22% increase in comparison with 2008 but a slight 11%
oesophageal candidiasis (9%) (Table 23). By transmis- decrease compared with 2012, which had the highest
sion mode, pulmonary TB, wasting syndrome due to HIV number of deaths reported for the decade (Table 25).
and oesophageal candidiasis were the most common
AIDS-defining diseases among people infected through
heterosexual sex (the three diseases together account- HIV and AIDS diagnoses in the
ing for 37% of reported events). The most common Centre
AIDS-defining diseases reported among people with
AIDS infected through injecting drug use were extrapul- HIV diagnoses in the Centre
monary TB, pulmonary TB and wasting syndrome due to The HIV epidemic in the Centre remains at a relatively
HIV (together accounting for 50% of reported events). low level compared to other parts of the Region, but the
Among the few AIDS cases infected through sex between number of new diagnoses is increasing more rapidly
men, Pneumocystis pneumonia, wasting syndrome due here than elsewhere, notably in people infected through
to HIV and pulmonary TB were the most common dis- sex between men. A total of 6205 people were newly
eases (Fig. 2.13). diagnosed with HIV in 2017 from the 15 countries in the
46
SURVEILLANCE REPORT HIV/AIDS surveillance in Europe 2018 – 2017 data
Fig. 2.11. Age-specific trends by gender in new HIV diagnoses with heterosexual transmission, East, 2008–2017
30–39 years
3000
40–49 years
≥ 50 years
2000
1000
0
2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
Year of diagnosis
30–39 years
3000
40–49 years
≥ 50 years
2000
1000
0
2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
Year of diagnosis
Note: data from Estonia, Russian Federation, Turkmenistan and Uzbekistan excluded due to inconsistent reporting during the period.
Centre of the WHO European Region, giving a rate of All 15 countries provided information on the transmis-
3.2 per 100 000 population (Table 1). The highest rates sion mode, and the 2017 data (Table A, Tables 4–7)
(> 3.0) were reported by Cyprus (10.0), Montenegro (4.1), indicate the following.
Poland (3.5), Turkey (3.5), Bulgaria (3.4), Romania (3.3)
• Twenty-eight per cent of those newly diagnosed and
and Albania (3.2), and the lowest (< 2.0) by Bosnia and
48% of new HIV diagnoses with a known route of
Herzegovina (0.3), Slovakia (1.3) and Slovenia (1.9).
transmission were infected through sex between men
The most affected age group in 2017 was 30–39-year- (1765) (Table 4). Sex between men was the predomi-
olds (35% of cases), while 14% of cases were diagnosed nant reported mode of transmission in 12 countries
in young people aged 15–24 years – the largest per- in 2017 (Bosnia and Herzegovina, Bulgaria, Croatia,
centage of young people among the three geographical Cyprus, the Czech Republic, Hungary, Montenegro,
areas (Table A, Table 9). The male-to-female ratio was Serbia, Slovakia, Slovenia, Poland and the former
5.8, higher than in both the West and the East, reflect- Yugoslav Republic of Macedonia) (Fig. 2.15).
ing that the central part of the Region is seeing a high • Twenty-seven per cent of those newly diagnosed
number of young MSM among newly diagnosed cases and 45% of new HIV diagnoses with a known route
compared with other parts of the Region. The high- of transmission were infected through heterosexual
est male-to-female ratios (> 15.0) were observed in transmission (1658) (Table 6), which was the main
Montenegro (25.0), Croatia (20.2), Slovenia (18.5) and reported mode of transmission in three countries
Serbia (16.8) (Fig. 2.14). (Albania, Romania and Turkey) (Fig. 2.15).
• Three per cent of those newly diagnosed and 5% of
new HIV diagnoses with a known route of transmission
47
HIV/AIDS surveillance in Europe 2018 – 2017 data SURVEILLANCE REPORT
Fig. 2.12. AIDS diagnoses, by transmission mode and year of diagnosis, East, 2008–2017
Arithmetic scale
6000
Mother-to-child transmission
Other/undetermined
4000
2000
0
2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
Year of diagnosis
Logarithmic scale
1000
Mother-to-child transmission
Other/undetermined
100
10
1
2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
Year of diagnosis
Note: data from the Russian Federation, Turkmenistan and Uzbekistan excluded due to inconsistent reporting during the period.
Fig. 2.13. Distribution of the three most common AIDS-defining illnesses per transmission mode, East, 2017
Heterosexual
transmission
0 5 10 15 20 25
Percentage
48
SURVEILLANCE REPORT HIV/AIDS surveillance in Europe 2018 – 2017 data
Montenegro
Croatia
Slovenia
Serbia
Slovakia
Czech Republic
Bulgaria
Hungary
Poland
Centre average
Turkey
Cyprus
Romania
Albania
0 5 10 15 20 25 30
Male-to-female ratio
were infected through injecting drug use (169) Trends in HIV diagnoses in the Centre
(Table 5).
The rate of new HIV diagnoses increased by 121%
• One per cent (0.6) was infected through mother-to- between 2008 and 2017 in the 15 countries of the
child transmission (35) (Table 7). Centre, from 1.4 per 100 000 population (2627 cases)
to 3.1 (6205 cases) (Fig. 2.3a, b). Rates increased in all
• Transmission mode was unknown for 41% of those
countries, particularly in the former Yugoslav Republic
newly diagnosed (2556) (Table 8). The two countries
of Macedonia (10-fold) and Turkey (five-fold), but it also
with the highest number of new HIV diagnoses in 2017
more than doubled in Bulgaria, Cyprus and Montenegro.
(Turkey and Poland – together accounting for 67% of
all new HIV diagnoses reported in the Centre in 2017) Information on trends by reported mode of HIV transmis-
also had the highest percentage of new HIV diagnoses sion for the period 2008–2017 in the 13 countries with
with an unknown transmission mode (Poland 66% and consistent data32 (Fig. 2.17) indicates the following.
Turkey 54%).
• The number of new diagnoses in those infected
Twelve of 15 countries provided information about CD4 through sex between men doubled, from 470 to 953.
cell count at HIV diagnosis for 1504 people aged over 14 The percentage of new HIV diagnoses attributed to
years (covering 24% of new diagnoses in the 15 Centre sex between men also increased, from 34% in 2008
countries and 86% in the 12 countries with CD4 cell data) to 47% in 2017.
(Table 14). Fifty-three per cent were late presenters, with
CD4 cell counts below 350 per mm3 at HIV diagnosis, • The number of new diagnoses in those infected
including 34% with advanced HIV infection (CD4 < 200/ through heterosexual transmission increased by 43%,
mm3). In all, 20% had a CD4 cell count of between 350 from 550 to 789. The percentage of new HIV diagno-
and 500 cells per mm3 and 28% had a CD4 cell count ses attributed to heterosexual transmission remained
above 500 per mm3. The proportion diagnosed with stable at 39%.
CD4 counts of less than 350/mm3 was above 50% in five • The number of new diagnoses in those infected
countries: Serbia (66%), Montenegro (62%), Romania through injecting drug use increased by 47%, from
(60%), Albania (59%) and Croatia (58%). The percentage 87 to 128. The 2011–2013 outbreak in Romania that
of late presenters varied across transmission catego- caused higher numbers of cases during this period
ries and was highest for those infected heterosexually has levelled off, as evidenced by the decrease in
(61%) and through injecting drug use (59%), and lowest new diagnoses since 2013. The percentage of new
for men infected through sex with men (43%) (Table 14,
Fig. 2.16).
49
HIV/AIDS surveillance in Europe 2018 – 2017 data SURVEILLANCE REPORT
Fig. 2.15. New HIV diagnoses, by country and transmission mode, Centre, 2017 (n = 6383)
Slovakia
Czech Republic
Slovenia
Serbia
Cyprus
Bulgaria
Hungary
Centre average
Poland
Romania
Turkey
Albania
0 20 40 60 80 100
Percentage
Fig. 2.16. New HIV diagnoses, by CD4 cell count per mm3 at diagnosis and transmission mode, Centre, 2017 (n = 1501)
≥ 500 cells/mm3
Heterosexual
n = 649
transmission
0 20 40 60 80 100
Percentage
diagnoses attributed to injecting drug use remained transmission mode. The percentage of new diagnoses
stable at 6%. with missing information about transmission mode
deceased from 19% in 2008 to 7% in 2017 in the 13
• The number of new diagnoses as a result of mother-
countries included in the trend assessment.
to-child transmission was similar in 2008 (18) and
2017 (20), but with slightly higher numbers during
AIDS cases, morbidity and mortality in the
2009–2013. Centre
• The number of new diagnoses reported with unknown In 2017, 823 people were diagnosed with AIDS in the
transmission mode, although still high at 41% in the 15 reporting countries in the Centre, corresponding
15 countries in 2017, decreased by 49% from 273 to a rate of 0.4 per 100 000 population (Table 15). The
to 138 in the 13 countries with consistent data on highest rates (> 1.0) were reported by Montenegro (2.1),
50
SURVEILLANCE REPORT HIV/AIDS surveillance in Europe 2018 – 2017 data
Fig. 2.17. New HIV diagnoses, by transmission mode and year of diagnosis, Centre, 2008–2017
Mother-to-child transmission
600 Other/undetermined
400
200
0
2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
Year of diagnosis
Note: data from Poland and Turkey excluded due to incomplete reporting on transmission mode during the period.
Cyprus (1.9), Romania (1.4) and Albania (1.1). AIDS rates The most common AIDS-indicative diseases diagnosed
remained below 0.8 per 100 000 population in other in 2017 were wasting syndrome due to HIV (19% of all
countries in the Centre. Contrary to the distribution of recorded disease events), Pneumocystis pneumonia
transmission modes for new HIV diagnoses in the Centre (13%) and pulmonary TB (12%) (Table 23).
(where sex between men is the predominant mode), more
AIDS diagnoses are reported in people infected through Mortality also remained stable in the Centre, with 261
heterosexual contact (41% of new diagnoses) compared deaths reported by the 15 countries in 2008 and 291 in
with sex between men (25% of new diagnoses). 2017, with little variation over the decade (and slightly
higher numbers during 2011–2015) (Table 24). As men-
The rate of new AIDS diagnoses remained stable at tioned in the “AIDS cases, morbidity and mortality”
0.4 per 100 000 between 2008 and 2017, with almost section above, these numbers do not represent the true
no change during the period (Fig. 2.5). Trends were burden of AIDS-related mortality due to underreporting
more heterogeneous at country level. Of the 12 coun- of deaths in countries that do not match their HIV/AIDS
tries reporting more than 10 AIDS cases in 2017, the registries with the national mortality registry.
rate increased by more than 50% in five (Bulgaria, the
Czech Republic, Hungary, Montenegro and Serbia) and
decreased by 40% or more in one (Poland) (Table 15).
HIV and AIDS diagnoses in the
In terms of the mode of transmission, new AIDS diag- West
noses increased mostly among men infected through
HIV diagnoses in the West
sex between men (by 65% for the decade) but have sta-
bilized or started to decline in all transmission groups The epidemiological pattern of HIV infection in the
since 2014 (Fig. 2.18). West largely mirrors that of the EU/EEA, as described in
Fig. 2.18. New AIDS diagnoses, by transmission mode and year of diagnosis, Centre, 2008–2017
300
Mother-to-child transmission
Other/undetermined
200
100
0
2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
Year of diagnosis
Note: data from Turkey excluded due to incomplete reporting on transmission mode during the period.
51
HIV/AIDS surveillance in Europe 2018 – 2017 data SURVEILLANCE REPORT
Chapter 1. In 2017, 22 354 people were newly diagnosed European Region and 11% (2167) from a European coun-
with HIV in the 22 reporting countries33 in the West of the try other than the country of report (Table 11).
WHO European Region, giving a rate of 6.4 per 100 000
population (not adjusted for reporting delay) (Table A, Trends in HIV diagnoses in the West
Table 1). When adjusting the 2017 West rate for reporting
The crude rate of new diagnoses in the 22 reporting
delay,34 it increases to 6.9 per 100 000 population (23
countries declined by 32% between 2008 and 2017, from
976 cases).
9.4 per 100 000 population (27 530) to 6.4 (22 354) (not
In 2017, the highest proportion of newly diagnosed HIV adjusted for reporting delay35). After adjusting the 2017
infections (30%) were in 30–39-year-olds, 11% were rate for reporting delay, the decline was 27% (from 9.4 to
aged 15–24 years and the male-to-female ratio was 2.9 6.9 per 100 000 population, with 23 976 cases in 2017).
(Table A). Sexual transmission between men remained HIV rates increased (by 10% or more in countries with
the main transmission mode in 2017, followed by het- > 10 cases in both 2008 and 2017) in only three countries,
erosexual transmission, together accounting for 74% of Iceland, Ireland and Malta, and decreased (by 10% or
all new diagnoses and 94.5% of all cases with a known more) in 14 (Table 1), not taking into account the impact
route of transmission. of reporting delays in several countries. Information
about trends by reported transmission mode during the
In the 17 countries reporting information on CD4 cell period 2008–2017 in the 20 countries with consistent
count at HIV diagnosis for 15 433 people over 14 years data36 (Fig. 2.19) suggests the following.
(covering 69% of all new diagnoses from the 22 report-
• New diagnoses of people infected through sex
ing countries in the West and 70% of new diagnoses
between men decreased by 21%, from 7349 to 5806.
from the 17 countries reporting information on CD4 cell
The percentage of new diagnoses attributed to sex
counts), 48% were late presenters with CD4 cell counts
between men increased from 34% in 2008 to 37% in
below 350 per mm3 at HIV diagnosis, including 28% with
2017.
advanced HIV infection (CD4 < 200/mm3) (Table 14). Late
presentation varied by transmission category and was • New diagnoses of people with reported heterosexual
more common in people infected heterosexually (57%) transmission decreased by 49%, from 10 039 to 5153,
or through injecting drug use (52%) and less common in with the steepest decline among women and foreign-
men infected through sex with men (39%) (Table 14). born heterosexuals, the latter being mainly due to
sharp declines among migrants originating from
Information about transmission mode (Table A, countries with generalized HIV epidemics (data not
Tables 4–7) suggests the following. shown; see also Fig. 1.11 and 1.12 and the “Trends in
• Forty per cent of all people newly diagnosed and 51% HIV diagnoses” section of Chapter 1). The percentage
of those with a known mode of transmission were of new diagnoses attributed to heterosexual contact
infected through sex between men (8872) (Table 4). decreased from 47% of cases in 2008 to 33% in 2017.
• Thirty-four per cent of all people newly diagnosed and • New diagnoses of people infected through inject-
44% of those with a known mode of transmission were ing drug use decreased by 57%, from 941 in 2008 to
infected heterosexually (7664) (Table 6). Of these, 404 in 2017, representing 4% of new HIV diagnoses in
60% were born abroad and 41% originated from gen- 2008 and 3% in 2017.
eralized epidemic countries (data not shown). • New diagnoses of children infected through mother-
• Three per cent of all people newly diagnosed were to-child transmission decreased by 60%, from 253 in
infected through injecting drug use (603) (Table 5). 2008 to 102 in 2017.
• Mother-to-child transmission accounted for 0.5% of all • The number of new diagnoses with missing informa-
new diagnoses and 0.7% of those with a known route tion about transmission mode increased by 51%, from
of transmission (120 cases) (Table 7). Of these, 78% 2741 to 4145, corresponding to 13% of new diagno-
were born abroad and 62% originated from countries ses in 2008 to 26% in 2017. Delays in the reporting
with a generalized epidemic (data not shown). of probable mode of transmission to national and
European surveillance systems intensify the increase.
• Transmission mode was unknown for 23% of all new
diagnoses (5032). AIDS cases, morbidity and mortality in the
West
Information about country of birth, country of national-
ity or region of origin was provided by 20 countries for Twenty of the 23 countries in the West 37 reported that
22 350 new diagnoses in 2017 (covering nearly 100% of 2426 people were diagnosed with AIDS in 2017, giving a
all new diagnoses). Region of origin was unknown for rate of 0.7 per 100 000 population (Table 15). The steady
15% (3406). Among 18 944 people with known origin decline in new AIDS diagnoses that began in the late
(85%), 47% (8950) originated from outside of the report-
ing country, including 36% (6783) from outside the WHO 35 See Annex 1 for methods and Annex 6 for results.
36 Data from Italy and Spain were excluded due to increasing coverage
33 Due to technical problems, no data export for 2017 was available of national surveillance over the period; data from Germany were
from Germany. excluded due to lack of data for 2017.
34 See Annex 1 for methods and Annex 6 for results. 37 No data were available from Belgium, Germany or Sweden.
52
SURVEILLANCE REPORT HIV/AIDS surveillance in Europe 2018 – 2017 data
Fig. 2.19. New HIV diagnoses, by transmission mode and year of diagnosis, West, 2008–2017
Mother-to-child transmission
8000
Other/undetermined
6000
4000
2000
0
2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
Year of diagnosis
Note: data from Germany excluded due to lack of data for 2017, data from Italy and Spain excluded due to increasing coverage of national surveillance during the
period.
1990s continued through to 2017, with a 59% decrease in West of the Region due to reporting delays and, particu-
the rate of new AIDS cases over the decade from 2.1 per larly, underreporting of deaths in countries without the
100 000 population (6516 cases) in 2008 to 0.7 (2426 ability to link their HIV/AIDS registries with their vital
cases) in 2017 (Fig. 2.5). New AIDS diagnoses decreased statistics registries.
in all transmission groups, but most notably among peo-
ple who inject drugs (an 84% decline) (Fig. 2.20).
HIV testing
The most common AIDS-indicative diseases diagnosed Data on the number of HIV tests can support the inter-
in the West in 2017 were Pneumocystis pneumonia (24% pretation of trends in newly diagnosed HIV infections. A
of all disease events reported), oesophageal candidiasis total of 24 153 146 HIV tests (excluding unlinked anon-
(11%) and Kaposi’s sarcoma (9%) (Table 23). ymous tests and screening of blood donations) were
reported by 30 countries (12 East, 10 Centre and 8 West)
In the West, 552 people were reported to have died in for 2017. Countries in the East tended to report higher
2017 in the 19 countries for which consistent data were testing rates than those in the West and Centre, but
available38 (Table 24). The number of AIDS-related rates varied greatly across countries from all parts of
deaths has continued to decline during the decade the Region, and more data were available from countries
from 2026 in 2008 to 552 in 2017, representing a 73% in the Centre and East than the West (Table 26).
decrease. As mentioned in the “AIDS cases, morbidity
and mortality” section above, these numbers do not The overall number of tests performed in the Region
reflect the true burden of AIDS-related mortality in the increased by 34%, from 17 551 854 in 2008 to 23 436
301 in 2017 in 28 countries with data for both 2008
38 No data were available from Belgium, Germany, Italy and Sweden. and 2017. Increases in large countries with high testing
Fig. 2.20. New AIDS diagnoses, by transmission mode and year of diagnosis, West, 2008–2017
3000
Mother-to-child transmission
Other/undetermined
2000
1000
0
2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
Year of diagnosis
Note: data from Belgium, Germany and Sweden excluded due to inconsistent reporting during the period.
53
HIV/AIDS surveillance in Europe 2018 – 2017 data SURVEILLANCE REPORT
numbers, such as Belarus, France, Kazakhstan, Turkey 3.2 per 100 000 population. Two countries (the Russian
and Ukraine, had a considerable impact on the overall Federation and Ukraine) continued to have a major influ-
increase. The number of tests more than doubled in ence on the overall epidemiology of HIV in the WHO
eight countries, but information about testing yield or European Region in 2017, contributing 75% of newly
coverage among key populations at higher risk of HIV diagnosed infections in the Region and 92% in the East.
infection is not available here.
The 2017 HIV surveillance data also confirm the great
The number of HIV tests from the 12 reporting countries variation of epidemic patterns and trends across the
in the East of the Region increased by 46%, from 5 818 WHO European Region. Overall, among the 160 000 new
930 in 2008 to 8 506 795 in 2017 (Table 27). Information diagnoses for whom the mode of HIV transmission was
about the types of populations tested is not avail- known, heterosexual transmission accounted for just
able, however, and increasing numbers of HIV tests do over half, injecting drug use for a third and sex between
not necessarily generate higher testing yields if large men for 15%. These overall numbers conceal a complex
numbers of HIV tests are performed among people at mix of transmission patterns, trends and country con-
low risk of HIV infection. It is nevertheless possible texts in which transmission through sex between men
that increased testing activity has contributed to the tends to predominate in the western and central parts
observed increase in new diagnoses. This is supported of the Region, heterosexual transmission remains sub-
by improved estimates of the first of the three UNAIDS stantial across large parts of the Region – particularly
and WHO 90–90–90 targets: at the end of 2017, an esti- among migrants, travellers and partners of people who
mated 74% of people living with HIV knew their status, inject drugs – and injecting drug use remains an impor-
up from 66% in 2015 (for more details on estimates, see tant risk factor, mainly in the eastern part of the Region.
UNAIDS (6)).
The increase in new diagnoses in the East of the Region
The rate of new HIV diagnoses in the Centre more than continued, with 2017 continuing the trend of recent
doubled during the last decade, while the number of HIV years in becoming the year with the highest number and
tests increased by 42% (from 6 010 936 in 2008 to 8 506 rate ever recorded. The relative burden of new diagno-
941 in 2017) in the 10 countries for which consistent data ses reported in the East is high and increasing, reaching
were available.39 While it is difficult to make assess- 82% in 2017. The rate of increase appears to be levelling
ments based on these crude numbers, it appears less off, however, with a 68% increase for the decade (com-
likely that increased testing has substantially contrib- pared with a doubling for the decade identified in last
uted to the observed increase in new diagnoses. year’s report) and a slight 2% increase for the last year.
The rate increased more slowly for the decade among
The number of HIV tests conducted in the West is not women than men.40
reported separately here. Contrary to countries in the
East and Centre, many in the West do not systematically In terms of modes of HIV transmission, the overall
collect data on the number of HIV tests performed. This increase is mainly the result of sustained increases
results in data that are too sparse to allow for meaning- among people with reported heterosexual transmission
ful interpretation. in all countries, meaning that this mode dominates, with
59% of new diagnoses in 2017 for whom the mode of HIV
Conclusions transmission was known. Transmission through inject-
ing drug use continued to decrease during the decade
HIV infection continues to affect the health and well- but still accounted for 37% of new diagnoses in the East
being of more than 2 million people in the WHO European with a known transmission mode. Transmission through
Region and to be of serious public health concern, par- sex between men remains low in absolute terms but
ticularly in the central and eastern parts of the Region. increased nearly eight-fold over the decade – the largest
New surveillance data for 2017 show that the increas- increase in any transmission category and any geo-
ing trend in new HIV diagnoses continued for the WHO graphical area of the Region. Limited available data on
European Region, but at a slower rate for the last decade the probable source of infection among people infected
than previously. The slowing rate of increase appears to through heterosexual contact suggests ongoing hetero-
be due mainly to fewer new diagnoses among women sexual transmission occurring outside of the reporting
than men, with some variation across the Region. countries and related to partners with a history of inject-
ing drug use. There is also some evidence to suggest
Nearly 160 000 people were diagnosed with HIV infec- that a proportion of men reported as heterosexually
tion in 2017, at a rate of 20.0 diagnoses per 100 000 infected may in fact be men who have sex with men or
population – once again the highest rate ever reported people with a history of drug injection who may have
for the Region. The vast (and increasing) majority of been misclassified as heterosexually infected (7). While
people newly diagnosed (82%) were from the East, with most new diagnoses (61%) were in men and new diagno-
a soaring rate of 51.1 per 100 000 population, while ses increased more rapidly among men than women, the
14% were diagnosed in the West with a rate of 6.4 per
100 000 population, and 4% in the Centre with a rate of
39 The 10 countries are Albania, the Czech Republic, Montenegro, 40 A drop in new diagnoses reported by Ukraine from 2014–2015
Poland, Romania, Serbia, Slovenia, Slovakia, the former Yugoslav onwards is affecting the trend for the East and is partly related to a
Republic of Macedonia and Turkey. lack of data from parts of Ukraine since then.
54
SURVEILLANCE REPORT HIV/AIDS surveillance in Europe 2018 – 2017 data
proportion of new diagnoses among women was much of civil society along the entire HIV continuum of ser-
higher in the East than elsewhere in the Region. vices, ranging from HIV prevention, to adherence, to ART.
Following repeat calls for urgent action, most recently by In the western part of the Region, there is a clear decline
the WHO Regional Director for Europe during a ministe- in the overall rate of new HIV diagnoses for the decade,
rial policy dialogue on HIV and related comorbidities in resulting primarily from decreases in new diagnoses
EECA (8), countries in the East of the Region are revamp- among MSM in specific countries (Austria, Belgium,
ing their political commitment and scaling up efforts to Denmark, the Netherlands, Norway, Spain and the United
implement the evidence-based actions and interven- Kingdom) and from declines among people infected
tions outlined in the WHO action plan for the health heterosexually, particularly women and people origi-
sector response to HIV in the WHO European Region (9), nating from countries with generalized HIV epidemics.
unanimously endorsed by all 53 Member States during Continued strong HIV combination prevention, including
the 66th Regional Committee for Europe in September the use of formal and informal PrEP, implementation of
2016. Country-specific roadmaps for accelerating and diversified and user-friendly HIV testing services with
scaling up efforts to reach the UNAIDS and WHO 2020 more frequent testing to facilitate earlier diagnosis, early
targets are being prepared as a follow-up action from linkage to care and rapid initiation of ART, and a strong
the ministerial policy dialogue with the goal of strength- focus on interventions designed to reach MSM (16,17)
ening political commitment and reinforcing a common have all contributed to the observed declines. While a
agenda among key policy-makers, partners, funders certain proportion of migrants, even those originating
and implementers. The recommended actions and inter- from HIV-endemic areas, are known to acquire HIV after
ventions of the action plan include: comprehensive HIV arrival in the EU/EEA (18–20), the extent to which the
combination-prevention strategies for people at risk of observed decreases can be explained by lower incidence
heterosexual and drug-injection-related transmission, of HIV in the migrant populations, reduced testing-seek-
including harm-reduction interventions for people who ing or opportunities, changed migration patterns or a
use drugs; condom and lubricant programming; diversi- combination of factors, is unclear.
fied HIV testing services (use of rapid diagnostic tests,
HIV testing provided by lay providers and HIV self-test- Across the WHO European Region where migrations
ing); assisted voluntary partner notification (10,11); occur widely in various forms, the public health chal-
PrEP; prevention and management of co-infections; and lenge of ensuring access to health services for migrant
a treat-all approach (12,13). Further interventions aimed populations, including HIV services, and promoting
at reducing stigma and discrimination and eliminating cross-border collaboration and sharing of data remains
laws and policies that hamper access to, and uptake of, essential to a robust and people-centred public health
crucial HIV prevention and treatment services for key response.
populations are needed to facilitate further progress in
As in previous years, it remains a major concern that
the reduction of HIV transmission (14).
over half (53%) of those newly diagnosed with HIV are
The rate of new diagnoses is increasing more rapidly only detected once their CD4 cell counts have fallen to
in the central part of the Region than anywhere else in below 350 per mm3. Importantly, the 2017 data provide
the WHO European Region, with a strong gender dis- once again information about variations in late presen-
parity and very steep increases among men (both MSM tation by geography, transmission mode and age, and
and heterosexual men) compared with a fairly stable confirm that the proportion diagnosed at a late stage of
rate among women. Sexual transmission prevails in all infection was highest in the East, among people infected
countries, with sex between men being the predominant heterosexually (particularly men) and through injecting
mode of transmission in 12 of the 15 Centre countries drug use, and among people in older age groups.
and reported heterosexual transmission prevailing in
Late presentation reflects insufficient access to, and
three. Drug-injection-related transmission remains
uptake of, HIV testing and counselling by those most
low but recent outbreaks (15) suggest that HIV pre-
at risk, as well as poor linkage to care after a positive
vention services for people who inject drugs continue
HIV diagnosis. HIV testing strategies need to be recon-
to be important and must be retained with sufficient
sidered and diversified, including through innovative
coverage among people who inject drugs to prevent
approaches that involve community-based organiza-
outbreaks. The percentage of young people among the
tions and focus on the most affected population groups.
new diagnoses is also higher in this part of the Region
Multiple entry points to HIV testing should be available
than elsewhere. HIV prevention, diagnostics and treat-
through, for example, HIV self-testing, HIV testing per-
ment interventions should accommodate the needs
formed by lay providers and civil society, home sampling,
of key populations, particularly MSM, with relevant
routine indicator condition-guided HIV testing offered in
evidence-based interventions, including: condom and
the health system and assisted partner notifications.
lubricant programming; diversified HIV testing services;
HIV testing should also be available in settings such
assisted voluntary partner notification; PrEP; prevention
as prisons, drug-dependence programmes, sexual and
and management of co-infections (particularly sexually
reproductive health clinics and migrant health services,
transmitted infections); and rapid HIV treatment initia-
depending on the local context. Support for timely link-
tion. Services should be patient-centred and provided in
age to HIV treatment and care is essential for reducing
a friendly environment, preferably with the involvement
late presentation and progressing toward the UNAIDS
55
HIV/AIDS surveillance in Europe 2018 – 2017 data SURVEILLANCE REPORT
and WHO 90–90–90 targets (21), improving treatment 7. Čakalo JI, Božičević I, Vitek CR, Mandel JS, Salyuk TO, Rutherford
GW. Misclassification of men with reported HIV infection in Ukraine.
outcomes and reducing further HIV transmission. AIDS Behav. 2015;19:1938–40.
8. Ministerial policy dialogue on HIV and related comorbidities in east-
AIDS trends varied greatly across the three geographi- ern Europe and central Asia. In: WHO Regional Office for Europe [web-
site]. Copenhagen: WHO Regional Office for Europe; 2018 (http://
cal areas. While the rate continued its steady decline w w w.euro.who.int/en/media-centre/events/events/2018/07/
in the West, it remained stable in the Centre and, while ministerial-policy-dialogue-on-hiv-and-related-comorbidities-in-
eastern-europe-and-central-asia).
still soaring and doubling over the decade in the East of 9. Action plan for the health sector response to HIV in the WHO
the Region, the AIDS rate has begun to stabilize and has European Region. Copenhagen: WHO Regional Office for Europe;
2016 (http://www.euro.who.int/en/health-topics/communicable-
even declined by a slight 7% in the East since 2012. The diseases/hivaids/publications/2017/action-plan-for-the-health-
high number of AIDS cases is indicative of late HIV diag- sector-response-to-hiv-in-the-who-european-region-2017).
nosis, delayed initiation of life-saving HIV treatment and 10. Consolidated guidelines on HIV testing services. Geneva:
World Health Organization; 2015 (http://www.who.int/hiv/pub/
low treatment coverage. However, increasing implemen- guidelines/hiv-testing-services/en/).
tation of a treat-all approach and having policies in place 11. Guidelines on HIV self-testing and partner notification. Supplement
to consolidated guidelines on HIV testing services. Geneva:
in most countries in the East to support everyone living World Health Organization; 2016 (http://www.who.int/hiv/pub/
with HIV to be offered ART regardless of disease stage self-testing/hiv-self-testing-guidelines/en/).
has helped stabilize AIDS trends and will, ultimately, 12. Consolidated guidelines on the use of antiretroviral drugs
for treating and preventing HIV infection. Recommendations
help prevent people from dying and reduce AIDS-related for a public health approach. Second edition. Geneva: World
Health Organization; 2016 (http://apps.who.int/iris/bitstr
deaths in line with global and regional targets (9,22,23). eam/10665/208825/1/9789241549684_eng.pdf?ua=1).
13. INSIGHT START Study Group. Initiation of antiretroviral
To help address the ongoing transmission of HIV in therapy in early asymptomatic HIV infection. N Engl J Med.
2015;373(9):795–807.
Europe, countries are urged to implement the action
14. Consolidated guidelines on HIV prevention, diagnosis, treat-
plan for the health sector response to HIV in the WHO ment and care for key populations. Geneva: World Health
European Region as part of an urgent, accelerated and Organization; 2014 (https://www.who.int/hiv/pub/guidelines/
keypopulations-2016/en/).
innovative response to HIV that aims to meet the regional 15. Hedrich D, Kalamara E, Sfetcu O, Pharris A, Noor A, Wiessing
targets for 2020 and end the AIDS epidemic in Europe L et al. Human immunodeficiency virus among people who
inject drugs: is risk increasing in Europe? Euro Surveill.
by 2030, in line with the SDGs (24). From December 2013;18(48):pii=20648 (http://www.eurosurveillance.org/
2017 to April 2018, the WHO Regional Office for Europe ViewArticle.aspx?ArticleId=20648).
collected examples of good practices in implementa- 16. HIV and STI prevention among men who have sex with men. ECDC
guidance. Stockholm: ECDC; 2014 (http://ecdc.europa.eu/en/pub-
tion of the action plan solicited from national health lications/Publications/hiv-sti-prevention-among-men-who-have-
authorities, national and international experts and civil sex-with-men-guidance.pdf).
17. United Nations Population Fund, Global Forum on MSM and
society organizations involved in HIV prevention, test- HIV, United Nations Development Programme, World Health
ing, treatment and care, and published 52 examples Organization, United States Agency for International Development,
the US President’s Emergency Plan for AIDS Relief, the Bill &
from 33 Member States in the first compendium of good Melinda Gates Foundation. Implementing comprehensive HIV and
practices from the WHO European Region (25). Other STI programmes with men who have sex with men. New York (NY):
United Nations Population Fund; 2015 (https://www.unfpa.org/pub-
recently published documents also share experiences of lications/implementing-comprehensive-hiv-and-sti-programmes-
successful HIV, viral hepatitis and tuberculosis interven- men-who-have-sex-men).
18. Rice BD, Elford J, Yin Z, Delpech VC. A new method to assign country
tions and good practices (26), as well as principles and of HIV infection among heterosexuals born abroad and diagnosed
actions for stronger intersectoral collaboration (27 ) aim- with HIV. AIDS 2012;26(15):1961–6.
ing to reach the SDGs and improving health outcomes 19. Fakoya I, Alvarez-del Arco D, Woode-Owusu M, Monge S, Rivero-
Montesdeoca Y, Delpech V et al. A systematic review of post-
and quality of life for people at risk of, or living with, the migration acquisition of HIV among migrants from countries with
generalised HIV epidemics living in Europe: implications for effec-
three diseases. tively managing HIV prevention programmes and policy. BMC Public
Health 2015;15:561.
References 20. Fakoya I, Alvarez-Del Arco D, Monge S, Copas AJ, Gennotte A-F, et
al. HIV testing history and access to treatment among migrants
1. Information note ‘Spravka’ on HIV infection in the Russian living with HIV in Europe. J Int AIDS Soc. 2018;21(Suppl. 4):e25123
Federation as of 31 December 2017. Moscow: Russian Federal (https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.25123).
Scientific and Methodological Centre for Prevention and Control of
AIDS; 2018. 21. Ambitious treatment targets: writing the final chap-
ter of the AIDS epidemic. Geneva: UNAIDS; 2014 (http://
2. Russian Federal Scientific and Methodological Centre for Prevention w w w. u n a i d s . o r g /s i t e s/d e f a u l t /f i l e s/m e d i a _ a s s e t /
and Control of AIDS. HIV-infection Bulletin No. 41. Moscow: Federal JC2670_UNAIDS_Treatment_Targets_en.pdf).
Service for Surveillance of Consumer Rights Protection and Human
Well-being; 2016. 22. Global health sector strategy for HIV 2016–2021. Geneva:
World Health Organization; 2016 (http://www.who.int/hiv/
3. Information note ‘Spravka’ on HIV infection in the Russian strategy2016-2021/ghss-hiv/en/).
Federation as of 31 December 2016. Moscow: Russian Federal
Scientific and Methodological Centre for Prevention and Control of 23. On the fast-track to end AIDS. 2016–2021 strategy. Geneva:
AIDS; 2017. UNAIDS; 2015 (http://www.unaids.org/sites/default/files/media_
asset/20151027_UNAIDS_PCB37_15_18_EN_rev1.pdf).
4. EuroHIV. EuroHIV 2006 survey on HIV and AIDS surveillance in the
WHO European Region. Saint-Maurice: Institut de veille sanitaire; 24. United Nations General Assembly resolution A/RES/70/1.
2007. Transforming our world: the 2030 Agenda for Sustainable
Development. New York (NY): United Nations; 2015 (https://sustain-
5. ECDC/WHO Regional Office for Europe. HIV/AIDS sur- abledevelopment.un.org/post2015/transformingourworld).
veillance in Europe 2017–2016 data. Stockholm: ECDC;
2017 (https://ecdc.europa.eu/en/publications-data/ 25. Compendium of good practices in the health sector response to HIV
hivaids-surveillance-europe-2017-2016-data). in the WHO European Region. Copenhagen: WHO Regional Office for
Europe; 2018 (http://www.euro.who.int/en/publications/abstracts/
6. Annex on methods. In: Miles to go. Global AIDS update 2018. compendium-of-good-practices-in-the-health-sector-response-to-
Geneva: UNAIDS; 2018:255–64 (http://www.unaids.org/sites/ hiv-in-the-who-european-region).
default/files/media_asset/miles-to-go_en.pdf).
56
SURVEILLANCE REPORT HIV/AIDS surveillance in Europe 2018 – 2017 data
26. European Commission Staff Working Document on Combatting 27. United Nations common position on ending HIV, TB and viral hepati-
HIV/AIDS, viral hepatitis and tuberculosis. Brussels: European tis through intersectoral collaboration. Copenhagen: WHO Regional
Commission; 2018 (https://ec.europa.eu/health/sites/health/files/ Office for Europe; 2018 (http://www.euro.who.int/__data/assets/
communicable_diseases/docs/swd_2018_387_en.pdf). pdf_file/0005/382559/ibc-health-common-position-paper-eng.
pdf?ua=1).
57
Tables
HIV/AIDS surveillance in Europe 2018 – 2017 data SURVEILLANCE REPORT
Table 1. New HIV diagnoses and rates per 100 000 population, by country and year of diagnosis (2008–2017) and
cumulative totals, in EU/EEA and other countries of the WHO European Region
61
HIV/AIDS surveillance in Europe 2018 – 2017 data SURVEILLANCE REPORT
Table 2. HIV diagnoses in males and rates per 100 000 population, by country and year of diagnosis (2008–2017) and
cumulative totals, in EU/EEA and other countries of the WHO European Region
62
SURVEILLANCE REPORT HIV/AIDS surveillance in Europe 2018 – 2017 data
63
HIV/AIDS surveillance in Europe 2018 – 2017 data SURVEILLANCE REPORT
Table 3. HIV diagnoses in females and rates per 100 000 population, by country and year of diagnosis (2008–2017) and
cumulative totals, in EU/EEA and other countries of the WHO European Region
64
SURVEILLANCE REPORT HIV/AIDS surveillance in Europe 2018 – 2017 data
65
HIV/AIDS surveillance in Europe 2018 – 2017 data SURVEILLANCE REPORT
Table 4. New HIV diagnoses in men infected through sex between men, by country and year of diagnosis (2008–2017)
and cumulative totals, in EU/EEA and other countries of the WHO European Region
Table 5. New HIV diagnoses in people infected through injecting drug use, by country and year of diagnosis (2008–
2017) and cumulative totals, in EU/EEA and other countries of the WHO European Region
Table 6. New HIV diagnoses in people infected through heterosexual contact, by country and year of diagnosis
(2008–2017) and cumulative totals, in EU/EEA and other countries of the WHO European Region
Table 7. New HIV diagnoses in people infected through mother-to-child transmission, by country and year of diagnosis
(2008–2017) and cumulative totals, in EU/EEA and other countries of the WHO European Region
Table 8. HIV diagnoses in 2017, by country of report, transmission mode and sex, in EU/EEA and other countries of the
WHO European Region
70
SURVEILLANCE REPORT HIV/AIDS surveillance in Europe 2018 – 2017 data
71
HIV/AIDS surveillance in Europe 2018 – 2017 data SURVEILLANCE REPORT
Table 9. HIV diagnoses in 2017, by country of report, age and sex, in EU/EEA and other countries of the WHO European
Region
72
SURVEILLANCE REPORT HIV/AIDS surveillance in Europe 2018 – 2017 data
73
SURVEILLANCE REPORT HIV/AIDS surveillance in Europe 2018 – 2017 data
Table 10. HIV diagnoses in people infected through heterosexual contact, by country and transmission subcategory,
cases diagnosed in 2017, in EU/EEA and other countries of the WHO European Region
Partner
Case from a Partner from from a non- Partner
generalized a generalized Bisexual
generalized injecting drug Other Unknown Total
Area Country, territory or areaa epidemic epidemic partner
epidemic user
country country country
N % N % N % N % N % N % N % N
EU/EEA
West Austria 18 23.1 1 1.3 0 0.0 1 1.3 0 0.0 0 0.0 58 74.4 78
West Belgium 142 46.4 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 164 53.6 306
Centre Bulgaria
Centre Croatia 0 0.0 0 0.0 0 0.0 0 0.0 1 12.5 0 0.0 7 87.5 8
Centre Cyprus 6 18.8 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 26 81.3 32
Centre Czech Republic 3 5.2 1 1.7 6 0.0 1 1.7 1 1.7 0 0.0 46 79.3 58
West Denmark 27 29.0 29 31.2 33 35.5 1 1.1 1 1.1 0 0.0 2 2.2 93
East Estonia 0 0.0 0 0.0 0 0.0 4 4.5 0 0.0 0 0.0 85 95.5 89
West Finland 13 18.6 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 57 81.4 70
West France 750 52.4 180 12.6 31 2.2 8 0.6 4 0.3 0 0.0 459 32.1 1 432
West Germanyb – – – – – – – – – – – – – – –
West Greece – – – – – – – – – – – – – – –
Centre Hungary – – – – – – – – – – – – – – –
West Iceland 1 50.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 50.0 2
West Ireland 82 57.7 17 12.0 0 0.0 1 0.7 1 0.7 0 0.0 41 28.9 142
West Italy – – – – – – – – – – – – – – –
East Latvia – – – – – – – – – – – – – – –
Liechtenstein – – – – – – – – – – – – – – –
East Lithuania – – – – – – – – – – – – – – –
West Luxembourg 7 23.3 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 23 76.7 30
West Malta 8 47.1 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 9 52.9 17
West Netherlands 26 16.1 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 135 83.9 161
West Norway 0 0.0 43 37.4 58 50.4 0 0.0 0 0.0 0 0.0 14 12.2 115
Centre Poland 0 0.0 0 0.0 1 1.1 0 0.0 0 0.0 0 0.0 93 98.9 94
West Portugal 143 23.4 21 3.4 124 20.3 2 0.3 0 0.0 0 0.0 322 52.6 612
Centre Romania 1 0.2 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 427 99.8 428
Centre Slovakia – – – – – – – – – – – – – – –
Centre Slovenia 0 0.0 0 0.0 0 0.0 0 0.0 1 10.0 0 0.0 9 90.0 10
West Spain – – – – – – – – – – – – – – –
West Sweden 107 50.5 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 105 49.5 212
West United Kingdom 648 44.9 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 795 55.1 1 443
Total EU/EEA 1 982 36.5 292 5.4 253 4.7 18 0.3 9 0.2 0 0.0 2 878 53.0 5 432
Non-EU/EEA
Centre Albania – – – – – – – – – – – – – – –
West Andorra 0 0.0 0 0.0 2 100.0 0 0.0 0 0.0 0 0.0 0 0.0 2
East Armenia 0 0.0 0 0.0 261 92.9 10 3.6 0 0.0 0 0.0 10 3.6 281
East Azerbaijan 1 0.3 0 0.0 77 23.1 34 10.2 1 0.3 0 0.0 221 66.2 334
East Belarus 1 0.1 0 0.0 112 6.0 53 2.8 0 0.0 0 0.0 1 702 91.1 1 868
Centre Bosnia and Herzegovina – – – – – – – – – – – – – – –
East Georgia 0 0.0 47 13.8 0 0.0 34 10.0 0 0.0 0 0.0 260 76.2 341
West Israel 58 34.7 32 19.2 0 0.0 2 1.2 1 0.6 0 0.0 74 44.3 167
East Kazakhstan 0 0.0 0 0.0 340 18.2 194 10.4 1 0.1 0 0.0 1 333 71.4 1 868
East Kyrgyzstan 0 0.0 0 0.0 0 0.0 72 14.7 5 1.0 0 0.0 413 84.3 490
West Monaco – – – – – – – – – – – – – – –
Centre Montenegro – – – – – – – – – – – – – – –
East Republic of Moldova 0 0.0 0 0.0 458 81.6 0 0.0 0 0.0 0 0.0 103 18.4 561
East Russian Federation – – – – – – – – – – – – – – –
West San Marino – – – – – – – – – – – – – – –
Centre Serbia 0 0.0 0 0.0 2 6.9 0 0.0 1 3.4 0 0.0 26 89.7 29
Centre Serbia excluding Kosovoc 0 0.0 0 0.0 1 3.7 0 0.0 1 3.7 0 0.0 25 92.6 27
Centre Kosovoc 0 0.0 0 0.0 1 50.0 0 0.0 0 0.0 0 0.0 1 50.0 2
West Switzerland 27 20.6 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 104 79.4 131
East Tajikistan 0 0.0 0 0.0 114 14.6 36 4.6 0 0.0 0 0.0 629 80.7 779
Centre The former Yugoslav Republic – – – – – – – – – – – – – – –
of Macedonia
Centre Turkey – – – – – – – – – – – – – – –
East Turkmenistan – – – – – – – – – – – – – – –
East Ukraine – – – – – – – – – – – – – – –
East Uzbekistan – – – – – – – – – – – – – – –
Total non-EU/EEA 87 1.3 79 1.2 1 366 19.9 435 6.3 9 0.1 0 0.0 4 875 71.2 6 851
WHO European Region
West 2 057 41.0 323 6.4 248 4.9 15 0.3 7 0.1 0 0.0 2 363 47.1 5 013
Centre 10 1.5 1 0.2 9 1.4 1 0.2 4 0.6 0 0.0 634 96.2 659
East 2 0.0 47 0.7 1 362 20.6 437 6.6 7 0.1 0 0.0 4 756 71.9 6 611
Total WHO European Region 2 069 16.8 371 3.0 1 619 13.2 453 3.7 18 0.1 0 0.0 7 753 63.1 12 283
a
ountry-specific comments are in Annex 5. Countries that do not report on the optional variable "transmission partner" are excluded and, thus, regional totals may
C
not equal those presented in Table 6.
b
Due to technical problems no data export for 2017 from Germany was available.
c
( in accordance with Security Council resolution 1244 (1999)). 75
HIV/AIDS surveillance in Europe 2018 – 2017 data SURVEILLANCE REPORT
Table 11. HIV diagnoses, by country of report and region of origin, cases diagnosed in 2017, in EU/EEA and other
countries of the WHO European Region
Country of report Western Europe Central and eastern Europe Sub-Saharan Africa
Area Country, territory or areaa
N % N % N % N %
EU/EEA
West Austria 141 52.2 15 5.6 68 25.2 21 7.8
West Belgium 266 29.9 64 7.2 39 4.4 211 23.7
Centre Bulgaria 234 97.1 3 1.2 4 1.7 0 0.0
Centre Croatia 87 82.1 1 0.9 14 13.2 1 0.9
Centre Cyprus 32 37.6 13 15.3 20 23.5 10 11.8
Centre Czech Republic 176 69.3 4 1.6 55 21.7 3 1.2
West Denmark 112 46.3 15 6.2 34 14.0 32 13.2
East Estonia 99 45.2 0 0.0 8 3.7 0 0.0
West Finland 70 44.3 3 1.9 31 19.6 20 12.7
West France 1 324 25.4 67 1.3 79 1.5 1 090 20.9
West Germanyb – – – – – – – –
West Greece 430 68.5 8 1.3 70 11.1 60 9.6
Centre Hungary – – – – – – – –
West Iceland 9 37.5 5 20.8 6 25.0 1 4.2
West Ireland 117 24.2 29 6.0 35 7.2 104 21.5
West Italy 2 249 65.3 24 0.7 174 5.1 652 18.9
East Latvia 365 98.4 1 0.3 3 0.8 0 0.0
Liechtenstein – – – – – – – –
East Lithuania 253 96.2 4 1.5 4 1.5 0 0.0
West Luxembourg 15 25.4 19 32.2 4 6.8 14 23.7
West Malta 16 35.6 8 17.8 7 15.6 8 17.8
West Netherlands 419 58.5 22 3.1 43 6.0 59 8.2
West Norway 74 34.7 16 7.5 24 11.3 43 20.2
Centre Poland 809 61.1 0 0.0 11 0.8 0 0.0
West Portugal 692 64.8 23 2.2 8 0.7 198 18.5
Centre Romania 653 98.8 2 0.3 0 0.0 1 0.2
Centre Slovakia 64 91.4 0 0.0 5 7.1 1 1.4
Centre Slovenia 33 84.6 0 0.0 3 7.7 0 0.0
West Spain 1 974 60.8 110 3.4 119 3.7 236 7.3
West Sweden 97 22.4 13 3.0 65 15.0 152 35.0
West United Kingdom 1 663 38.1 359 8.2 377 8.6 806 18.5
Total EU/EEA 12 473 49.6 828 3.3 1 310 5.2 3 723 14.8
Non-EU/EEA
Centre Albania 94 100.0 0 0.0 0 0.0 0 0.0
West Andorra 2 33.3 4 66.7 0 0.0 0 0.0
East Armenia 354 100.0 0 0.0 0 0.0 0 0.0
East Azerbaijan 559 98.1 0 0.0 10 1.8 1 0.2
East Belarus 2 464 99.8 0 0.0 2 0.1 1 0.0
Centre Bosnia and Herzegovina 12 100.0 0 0.0 0 0.0 0 0.0
East Georgia 629 99.7 0 0.0 2 0.3 0 0.0
West Israel 133 32.8 5 1.2 104 25.7 78 19.3
East Kazakhstan 2 864 94.9 0 0.0 136 4.5 0 0.0
East Kyrgyzstan 796 94.8 1 0.1 35 4.2 1 0.1
West Monaco – – – – – – – –
Centre Montenegro 26 100.0 0 0.0 0 0.0 0 0.0
East Republic of Moldova 836 100.0 0 0.0 0 0.0 0 0.0
East Russian Federation – – – – – – – –
West San Marino – – – – – – – –
Centre Serbia 179 98.9 0 0.0 2 1.1 0 0.0
Centre Serbia excluding Kosovoc 176 98.9 0 0.0 2 1.1 0 0.0
Centre Kosovoc 3 100.0 0 0.0 0 0.0 0 0.0
West Switzerland 191 43.1 53 12.0 18 4.1 50 11.3
East Tajikistan 1 204 99.7 0 0.0 1 0.1 0 0.0
Centre The former Yugoslav Republic of Macedonia 44 100.0 0 0.0 0 0.0 0 0.0
Centre Turkey 2 384 83.8 35 1.2 175 6.2 63 2.2
East Turkmenistan – – – – – – – –
East Ukraine 15 680 100.0 0 0.0 0 0.0 0 0.0
East Uzbekistan – – – – – – – –
Total non-EU/EEA 28 451 95.9 98 0.3 485 1.6 194 0.7
WHO European Region
West West 9 994 44.7 862 3.9 1 305 5.8 3 835 17.2
Centre Centre 4 827 80.7 58 1.0 289 4.8 79 1.3
East East 26 103 98.7 6 0.0 201 0.8 3 0.0
Total WHO European Region 40 924 74.7 926 1.7 1 795 3.3 3 917 7.1
a
Country-specific comments are in Annex 5. Countries that do not report on the variables "country of birth", "country of nationality" or "region of origin" are excluded
and therefore regional totals may not equal those presented in Table 1.
b
Due to technical problems no data export for 2017 from Germany was available.
c
( in accordance with Security Council resolution 1244 (1999)).
76
SURVEILLANCE REPORT HIV/AIDS surveillance in Europe 2018 – 2017 data
Latin America and Caribbean South and south-east Asia Other Unknown
Total Country, territory or areaa
N Rate N % N % N %
EU/EEA
7 2.6 12 4.4 5 1.9 1 0.4 270 Austria
48 5.4 26 2.9 31 3.5 205 23.0 890 Belgium
0 0.0 0 0.0 0 0.0 0 0.0 241 Bulgaria
0 0.0 1 0.9 2 1.9 0 0.0 106 Croatia
1 1.2 8 9.4 1 1.2 0 0.0 85 Cyprus
7 2.8 5 2.0 4 1.6 0 0.0 254 Czech Republic
13 5.4 21 8.7 15 6.2 0 0.0 242 Denmark
0 0.0 3 1.4 0 0.0 109 49.8 219 Estonia
3 1.9 11 7.0 3 1.9 17 10.8 158 Finland
216 4.1 52 1.0 124 2.4 2 259 43.4 5 211 France
– – – – – – – – – Germanyb
2 0.3 28 4.5 16 2.5 14 2.2 628 Greece
– – – – – – – – – Hungary
0 0.0 1 4.2 2 8.3 0 0.0 24 Iceland
83 17.2 18 3.7 7 1.4 90 18.6 483 Ireland
233 6.8 45 1.3 51 1.5 15 0.4 3 443 Italy
0 0.0 0 0.0 0 0.0 2 0.5 371 Latvia
– – – – – – – – – Liechtenstein
0 0.0 0 0.0 2 0.8 0 0.0 263 Lithuania
2 3.4 1 1.7 4 6.8 0 0.0 59 Luxembourg
3 6.7 3 6.7 0 0.0 0 0.0 45 Malta
72 10.1 34 4.7 36 5.0 31 4.3 716 Netherlands
15 7.0 20 9.4 7 3.3 14 6.6 213 Norway
0 0.0 0 0.0 0 0.0 505 38.1 1 325 Poland
110 10.3 3 0.3 0 0.0 34 3.2 1 068 Portugal
0 0.0 0 0.0 0 0.0 5 0.8 661 Romania
0 0.0 0 0.0 0 0.0 0 0.0 70 Slovakia
0 0.0 0 0.0 0 0.0 3 7.7 39 Slovenia
609 18.7 20 0.6 66 2.0 115 3.5 3 249 Spain
25 5.8 48 11.1 23 5.3 11 2.5 434 Sweden
260 6.0 259 5.9 123 2.8 516 11.8 4 363 United Kingdom
1 709 6.8 619 2.5 522 2.1 3 946 15.7 25 130 Total EU/EEA
Non-EU/EEA
0 0.0 0 0.0 0 0.0 0 0.0 94 Albania
0 0.0 0 0.0 0 0.0 0 0.0 6 Andorra
0 0.0 0 0.0 0 0.0 0 0.0 354 Armenia
0 0.0 0 0.0 0 0.0 0 0.0 570 Azerbaijan
0 0.0 1 0.0 0 0.0 0 0.0 2 468 Belarus
0 0.0 0 0.0 0 0.0 0 0.0 12 Bosnia and Herzegovina
0 0.0 0 0.0 0 0.0 0 0.0 631 Georgia
14 3.5 9 2.2 62 15.3 0 0.0 405 Israel
0 0.0 1 0.0 18 0.6 0 0.0 3 019 Kazakhstan
0 0.0 7 0.8 0 0.0 0 0.0 840 Kyrgyzstan
– – – – – – – – – Monaco
0 0.0 0 0.0 0 0.0 0 0.0 26 Montenegro
0 0.0 0 0.0 0 0.0 0 0.0 836 Republic of Moldova
– – – – – – – – – Russian Federation
– – – – – – – – – San Marino
0 0.0 0 0.0 0 0.0 0 0.0 181 Serbia
0 0.0 0 0.0 0 0.0 0 0.0 178 Serbia excluding Kosovoc
0 0.0 0 0.0 0 0.0 0 0.0 3 Kosovoc
23 5.2 13 2.9 11 2.5 84 19.0 443 Switzerland
0 0.0 0 0.0 3 0.2 0 0.0 1 208 Tajikistan
0 0.0 0 0.0 0 0.0 0 0.0 44 The former Yugoslav Republic of Macedonia
6 0.2 36 1.3 61 2.1 84 3.0 2 844 Turkey
– – – – – – – – – Turkmenistan
0 0.0 0 0.0 0 0.0 0 0.0 15 680 Ukraine
– – – – – – – – – Uzbekistan
43 0.1 67 0.2 155 0.5 168 0.6 29 661 Total non-EU/EEA
WHO European Region
1 738 7.8 624 2.8 586 2.6 3 406 15.2 22 350 West
14 0.2 50 0.8 68 1.1 597 10.0 5 982 Centre
0 0.0 12 0.0 23 0.1 111 0.4 26 459 East
1 752 3.2 686 1.3 677 1.2 4 114 7.5 54 791 Total WHO European Region
77
HIV/AIDS surveillance in Europe 2018 – 2017 data SURVEILLANCE REPORT
Table 12. HIV diagnoses, by geographical area, transmission mode and country or subcontinent of origin, in cases
reported in 2017
Country of report Western Europe Central and eastern Europe Sub-Saharan Africa
Transmission mode
N % N % N % N %
EU/EEA
Sex between men 6 153 63.5 548 5.7 510 5.3 228 2.4
Injecting drug use 708 76.2 38 4.1 121 13.0 7 0.8
Heterosexual contact 3 777 45.0 158 1.9 480 5.7 2 932 34.9
Mother-to-child 48 35.3 5 3.7 5 3.7 64 47.1
Haemophiliac/transfusion recipient 13 22.0 2 3.4 12 20.3 24 40.7
Nosocomial infection 3 30.0 0 0.0 2 20.0 2 20.0
Other/undetermined 1 771 28.9 77 1.3 180 2.9 466 7.6
Total EU-EEA 12 473 49.2 828 3.3 1 310 5.2 3 723 14.7
Non-EU/EEA
Sex between men 1 839 92.9 37 1.9 31 1.6 0 0.0
Injecting drug use 6 137 98.7 3 0.0 69 1.1 0 0.0
Heterosexual contact 18 372 97.7 20 0.1 211 1.1 108 0.6
Mother-to-child 247 94.6 0 0.0 3 1.1 7 2.7
Haemophiliac/transfusion recipient 10 76.9 0 0.0 1 7.7 1 7.7
Nosocomial infection 22 95.7 0 0.0 0 0.0 0 0.0
Other/undetermined 1 824 77.0 38 1.6 170 7.2 78 3.3
Total non-EU/EEA 28 451 95.9 98 0.3 485 1.6 194 0.7
Country of report Western Europe Central and eastern Europe Sub-Saharan Africa
Transmission mode
N % N % N % N %
West
Sex between men 5 589 63.0 566 6.4 474 5.3 226 2.5
Injecting drug use 360 59.7 39 6.5 149 24.7 7 1.2
Heterosexual contact 2 987 39.0 171 2.2 481 6.3 3 023 39.4
Mother-to-child 25 20.8 5 4.2 5 4.2 71 59.2
Haemophiliac/transfusion recipient 12 21.8 2 3.6 9 16.4 25 45.5
Nosocomial infection 2 28.6 0 0.0 0 0.0 2 28.6
Other/undetermined 1 019 20.3 79 1.6 187 3.7 481 9.6
Total West 9 994 44.7 862 3.9 1 305 5.8 3 835 17.2
Centre
Sex between men 1 384 78.4 19 1.1 58 3.3 2 0.1
Injecting drug use 155 91.7 0 0.0 4 2.4 0 0.0
Heterosexual contact 1 452 87.6 6 0.4 82 4.9 15 0.9
Mother-to-child 30 85.7 0 0.0 1 2.9 0 0.0
Haemophiliac/transfusion recipient 5 45.5 0 0.0 4 36.4 0 0.0
Nosocomial infection 8 72.7 0 0.0 2 18.2 0 0.0
Other/undetermined 1 793 70.1 33 1.3 138 5.4 62 2.4
Total Centre 4 827 77.8 58 0.9 289 4.7 79 1.3
East
Sex between men 1 019 98.4 0 0.0 9 0.9 0 0.0
Injecting drug use 6 330 99.3 2 0.0 37 0.6 0 0.0
Heterosexual contact 17 710 99.0 1 0.0 128 0.7 2 0.0
Mother-to-child 240 99.2 0 0.0 2 0.8 0 0.0
Haemophiliac/transfusion recipient 6 100.0 0 0.0 0 0.0 0 0.0
Nosocomial infection 15 100.0 0 0.0 0 0.0 0 0.0
Other/undetermined 783 86.7 3 0.3 25 2.8 1 0.1
Total East 26 103 98.7 6 0.0 201 0.8 3 0.0
Total WHO European Region 4 0 924 74.4 1 852 1.7 3 590 3.3 7 834 7.1
78
SURVEILLANCE REPORT HIV/AIDS surveillance in Europe 2018 – 2017 data
Latin America and Caribbean South and south-east Asia Other Unknown
Total Transmission mode
N % N % N % N %
EU/EEA
1 144 11.8 317 3.3 270 2.8 524 5.4 9 694 Men who have sex with men
9 1.0 9 1.0 9 1.0 28 3.0 929 Injecting drug use
396 4.7 202 2.4 171 2.0 286 3.4 8 402 Heterosexual contact
0 0.0 4 2.9 4 2.9 6 4.4 136 Mother-to-child
3 5.1 4 6.8 0 0.0 1 1.7 59 Haemophiliac/transfusion recipient
0 0.0 3 30.0 0 0.0 0 0.0 10 Nosocomial infection
157 2.6 80 1.3 68 1.1 3 324 54.3 6 123 Other/undetermined
1 709 6.7 619 2.4 522 2.1 4 169 16.4 25 353 Total EU-EEA
Non-EU/EEA
24 1.2 11 0.6 19 1.0 18 0.9 1 979 Men who have sex with men
2 0.0 0 0.0 5 0.1 2 0.0 6 218 Injecting drug use
12 0.1 24 0.1 37 0.2 18 0.1 18 802 Heterosexual contact
0 0.0 0 0.0 2 0.8 2 0.8 261 Mother-to-child
0 0.0 0 0.0 1 7.7 0 0.0 13 Haemophiliac/transfusion recipient
0 0.0 0 0.0 0 0.0 1 4.3 23 Nosocomial infection
5 0.2 32 1.4 91 3.8 130 5.5 2 368 Other/undetermined
43 0.1 67 0.2 155 0.5 171 0.6 29 664 Total non-EU/EEA
Latin America and Caribbean South and south-east Asia Other Unknown
Total Transmission mode
N % N % N % N %
West
1 162 13.1 312 3.5 277 3.1 266 3.0 8 872 Men who have sex with men
11 1.8 9 1.5 9 1.5 19 3.2 603 Injecting drug use
403 5.3 209 2.7 187 2.4 203 2.6 7 664 Heterosexual contact
0 0.0 4 3.3 5 4.2 5 4.2 120 Mother-to-child
3 5.5 3 5.5 0 0.0 1 1.8 55 Haemophiliac/transfusion recipient
0 0.0 3 42.9 0 0.0 0 0.0 7 Nosocomial infection
159 3.2 84 1.7 108 2.1 2 915 57.9 5 032 Other/undetermined
1 738 7.8 624 2.8 586 2.6 3 409 15.3 22 353 Total West
Centre
6 0.3 14 0.8 10 0.6 272 15.4 1 765 Men who have sex with men
0 0.0 0 0.0 0 0.0 10 5.9 169 Injecting drug use
5 0.3 10 0.6 9 0.5 79 4.8 1 658 Heterosexual contact
0 0.0 0 0.0 1 2.9 3 8.6 35 Mother-to-child
0 0.0 1 9.1 1 9.1 0 0.0 11 Haemophiliac/transfusion recipient
0 0.0 0 0.0 0 0.0 1 9.1 11 Nosocomial infection
3 0.1 25 1.0 47 1.8 455 17.8 2 556 Other/undetermined
14 0.2 50 0.8 68 1.1 820 13.2 6 205 Total Centre
East
0 0.0 2 0.2 2 0.2 4 0.4 1 036 Men who have sex with men
0 0.0 0 0.0 5 0.1 1 0.0 6 375 Injecting drug use
0 0.0 7 0.0 12 0.1 22 0.1 17 882 Heterosexual contact
0 0.0 0 0.0 0 0.0 0 0.0 242 Mother-to-child
0 0.0 0 0.0 0 0.0 0 0.0 6 Haemophiliac/transfusion recipient
0 0.0 0 0.0 0 0.0 0 0.0 15 Nosocomial infection
0 0.0 3 0.3 4 0.4 84 9.3 903 Other/undetermined
0 0.0 12 0.0 23 0.1 111 0.4 26 459 Total East
3 504 3.2 1 372 1.2 1 354 1.2 8 680 7.9 55 017 Total WHO European Region
79
HIV/AIDS surveillance in Europe 2018 – 2017 data SURVEILLANCE REPORT
Table 13. New HIV diagnoses, by country of report and probable region of infection, in 2017, in EU/EEA and other
countries of the WHO European Region
Country of report Western Europe Central and eastern Europe Sub-Saharan Africa
Area Country, territory or areaa
N % N % N % N %
EU/EEA
West Austria 26 9.6 3 1.1 3 1.1 3 1.1
West Belgium 174 19.6 23 2.6 13 1.5 83 9.3
Centre Bulgaria – – – – – – – –
Centre Croatia – – – – – – – –
Centre Cyprus 39 45.9 15 17.6 5 5.9 9 10.6
Centre Czech Republic 13 5.1 4 1.6 15 5.9 1 0.4
West Denmark 110 45.5 16 6.6 25 10.3 29 12.0
East Estonia 101 46.1 3 1.4 3 1.4 0 0.0
West Finland 28 17.7 8 5.1 40 25.3 18 11.4
West France 1 150 22.1 0 0.0 0 0.0 0 0.0
West Germanyb – – – – – – – –
West Greece – – – – – – – –
Centre Hungary – – – – – – – –
West Iceland 9 37.5 5 20.8 5 20.8 1 4.2
West Ireland 93 19.3 28 5.8 12 2.5 50 10.4
West Italy
East Latvia 219 59.0 2 0.5 5 1.3 0 0.0
Liechtenstein
East Lithuania 0 0.0 4 1.5 6 2.3 0 0.0
West Luxembourg 19 32.2 1 1.7 0 0.0 0 0.0
West Malta 16 35.6 0 0.0 0 0.0 0 0.0
West Netherlands 411 57.4 21 2.9 11 1.5 18 2.5
West Norway 0 0.0 20 9.4 19 8.9 53 24.9
Centre Poland 0 0.0 0 0.0 2 0.2 0 0.0
West Portugal 659 61.7 23 2.2 3 0.3 125 11.7
Centre Romania 653 98.8 2 0.3 0 0.0 1 0.2
Centre Slovakia 0 0.0 6 8.6 5 7.1 0 0.0
Centre Slovenia 25 64.1 1 2.6 3 7.7 0 0.0
West Spain – – – – – – – –
West Sweden 77 17.7 38 8.8 58 13.4 141 32.5
West United Kingdom 1 915 43.9 230 5.3 170 3.9 491 11.3
Total EU/EEA 5 737 32.9 453 2.6 403 2.3 1 023 5.9
Non-EU/EEA
Centre Albania 89 94.7 5 5.3 0 0.0 0 0.0
West Andorra
East Armenia 142 40.1 0 0.0 198 55.9 0 0.0
East Azerbaijan 293 51.4 0 0.0 133 23.3 1 0.2
East Belarus 2 424 98.2 4 0.2 37 1.5 1 0.0
Centre Bosnia and Herzegovina 7 58.3 0 0.0 0 0.0 0 0.0
East Georgia 1 0.2 0 0.0 0 0.0 0 0.0
West Israel 207 51.1 4 1.0 60 14.8 52 12.8
East Kazakhstan 2 864 94.9 0 0.0 136 4.5 0 0.0
East Kyrgyzstan 763 90.8 1 0.1 67 8.0 1 0.1
West Monaco – – – – – – – –
Centre Montenegro – – – – – – – –
East Republic of Moldova 836 100.0 0 0.0 0 0.0 0 0.0
East Russian Federation – – – – – – – –
West San Marino – – – – – – – –
Centre Serbia 0 0.0 0 0.0 2 1.1 0 0.0
Centre Serbia excluding Kosovoc 0 0.0 0 0.0 2 1.1 0 0.0
Centre Kosovoc – – – – – – – –
West Switzerland 154 34.8 30 6.8 9 2.0 36 8.1
East Tajikistan – – – – – – – –
Centre The former Yugoslav Republic of Macedonia 44 100.0 0 0.0 0 0.0 0 0.0
Centre Turkey 2 384 83.8 0 0.0 0 0.0 0 0.0
East Turkmenistan – – – – – – – –
East Ukraine – – – – – – – –
East Uzbekistan – – – – – – – –
Total non-EU/EEA 10 208 80.1 44 0.3 642 5.0 91 0.7
WHO European Region
West 5 048 33.6 450 3.0 428 2.8 1 100 7.3
Centre 3 254 58.0 33 0.6 32 0.6 11 0.2
East 7 643 79.9 14 0.1 585 6.1 3 0.0
Total WHO European Region 15 945 52.8 497 1.6 1 045 3.5 1 114 3.7
a
Country-specific comments are in Annex 5. Countries that do not report on the variables "country of birth", "country of nationality" or "region of origin" are excluded
and therefore regional totals may not equal those presented in Table 1.
b
Due to technical problems no data export for 2017 from Germany was available.
c
( in accordance with Security Council resolution 1244 (1999)).
80
SURVEILLANCE REPORT HIV/AIDS surveillance in Europe 2018 – 2017 data
Latin America and Caribbean South and south-east Asia Other Unknown
Total Country, territory or areaa
N Rate N % N % N %
EU/EEA
0 0.0 5 1.9 0 0.0 230 85.2 270 Austria
10 1.1 14 1.6 12 1.3 561 63.0 890 Belgium
– – – – – – – – – Bulgaria
– – – – – – – – – Croatia
1 1.2 5 5.9 1 1.2 10 11.8 85 Cyprus
2 0.8 4 1.6 3 1.2 212 83.5 254 Czech Republic
7 2.9 32 13.2 11 4.5 12 5.0 242 Denmark
0 0.0 3 1.4 0 0.0 109 49.8 219 Estonia
1 0.6 23 14.6 3 1.9 37 23.4 158 Finland
0 0.0 0 0.0 0 0.0 4 061 77.9 5 211 France
– – – – – – – – – Germanyb
– – – – – – – – – Greece
– – – – – – – – – Hungary
0 0.0 1 4.2 0 0.0 3 12.5 24 Iceland
58 12.0 19 3.9 14 2.9 209 43.3 483 Ireland
– – – – – – – – – Italy
0 0.0 1 0.3 0 0.0 144 38.8 371 Latvia
– – – – – – – – – Liechtenstein
0 0.0 0 0.0 0 0.0 253 96.2 263 Lithuania
1 1.7 0 0.0 0 0.0 38 64.4 59 Luxembourg
0 0.0 0 0.0 0 0.0 29 64.4 45 Malta
24 3.4 19 2.7 13 1.8 199 27.8 716 Netherlands
15 7.0 40 18.8 8 3.8 58 27.2 213 Norway
0 0.0 0 0.0 0 0.0 1 323 99.8 1 325 Poland
45 4.2 1 0.1 1 0.1 211 19.8 1 068 Portugal
0 0.0 0 0.0 0 0.0 5 0.8 661 Romania
0 0.0 0 0.0 1 1.4 58 82.9 70 Slovakia
0 0.0 1 2.6 1 2.6 8 20.5 39 Slovenia
– – – – – – – – – Spain
18 4.1 63 14.5 21 4.8 18 4.1 434 Sweden
108 2.5 227 5.2 83 1.9 1 139 26.1 4 363 United Kingdom
290 1.7 458 2.6 172 1.0 8 927 51.1 17 463 Total EU/EEA
Non-EU/EEA
0 0.0 0 0.0 0 0.0 0 0.0 94 Albania
– – – – – – – – – Andorra
0 0.0 0 0.0 0 0.0 14 4.0 354 Armenia
0 0.0 2 0.4 1 0.2 140 24.6 570 Azerbaijan
0 0.0 2 0.1 0 0.0 0 0.0 2 468 Belarus
0 0.0 0 0.0 0 0.0 5 41.7 12 Bosnia and Herzegovina
0 0.0 0 0.0 0 0.0 630 99.8 631 Georgia
8 2.0 9 2.2 12 3.0 53 13.1 405 Israel
0 0.0 1 0.0 0 0.0 18 0.6 3 019 Kazakhstan
0 0.0 8 1.0 0 0.0 0 0.0 840 Kyrgyzstan
– – – – – – – – – Monaco
– – – – – – – – – Montenegro
0 0.0 0 0.0 0 0.0 0 0.0 836 Republic of Moldova
– – – – – – – – – Russian Federation
– – – – – – – – – San Marino
0 0.0 0 0.0 0 0.0 179 98.9 181 Serbia
0 0.0 0 0.0 0 0.0 176 98.9 178 Serbia excluding Kosovoc
– – – – – – – – – Kosovoc
13 2.9 17 3.8 5 1.1 179 40.4 443 Switzerland
– – – – – – – – – Tajikistan
0 0.0 0 0.0 0 0.0 0 0.0 44 The former Yugoslav Republic of Macedonia
0 0.0 0 0.0 0 0.0 460 16.2 2 844 Turkey
– – – – – – – – – Turkmenistan
– – – – – – – – – Ukraine
– – – – – – – – – Uzbekistan
21 0.2 39 0.3 18 0.1 1 675 13.1 12 738 Total non-EU/EEA
WHO European Region
308 2.1 470 3.1 183 1.2 7 037 46.8 15 024 West
3 0.1 10 0.2 6 0.1 2 257 40.3 5 606 Centre
0 0.0 17 0.2 1 0.0 1 308 13.7 9 571 East
311 1.0 497 1.6 190 0.6 10 602 35.1 30 201 Total WHO European Region
81
SURVEILLANCE REPORT HIV/AIDS surveillance in Europe 2018 – 2017 data
Table 14. Percentage of new HIV diagnoses (2017) among people > 14 years reported with information about CD4 cell
count, by CD4 cell count level (< 200 and < 350 cells per mm³ blood) and by transmission mode in cases with CD4 < 350,
in EU/EEA and other countries of the WHO European Region
Number of CD4 < 200 (%) CD4 < 350 (%) CD4 < 350 mm³ (%)
Completeness
Area Country, territory or areaa cases with CD4 Injecting
(%) CD4b N % N % Heterosexualb MSMb
cell count drug userb
EU/EEA
West Austria 261 96.7 78 29.9 125 47.9 60.8 58.3 38.3
West Belgium 599 68.3 137 22.9 251 41.9 49.0 0.0 36.8
Centre Bulgaria 184 77.3 43 23.4 88 47.8 60.3 27.8 43.7
Centre Croatia 102 96.2 38 37.3 59 57.8 75.0 – 55.9
Centre Cyprus 75 88.2 16 21.3 31 41.3 56.7 – 26.8
Centre Czech Republic 230 90.9 49 21.3 75 32.6 48.1 – 27.4
West Denmarkd 129 92.1 32 24.8 60 46.5 52.9 – 39.4
East Estonia 78 35.6 22 28.2 42 53.8 62.0 14.3 75.0
West Finland 124 79.0 38 30.6 60 48.4 58.5 33.3 40.7
West France 2 374 45.9 637 26.8 1 144 48.2 55.3 43.8 37.3
West Germanyc – – – – – – – – –
West Greece 431 68.7 155 36.0 245 56.8 68.2 55.4 49.4
Centre Hungary – – – – – – – – –
West Iceland – – – – – – – – –
West Irelandd 155 49.1 44 28.4 82 52.9 63.6 – 44.0
West Italy 2 701 78.8 977 36.2 1 511 55.9 61.9 63.2 46.0
East Latvia 213 58.0 80 37.6 132 62.0 67.8 28.2 84.6
Liechtenstein – – – – – – – – –
East Lithuania 104 39.7 39 37.5 69 66.3 70.8 46.7 76.5
West Luxembourg 46 78.0 17 37.0 23 50.0 70.8 11.1 30.0
West Malta 31 73.8 9 29.0 17 54.8 57.1 – 42.9
West Netherlands 637 90.7 161 25.3 287 45.1 57.9 – 38.2
West Norway – – – – – – – – –
Centre Poland – – – – – – – – –
West Portugal 901 84.7 280 31.1 464 51.5 57.7 69.2 39.9
Centre Romania 607 94.1 234 38.6 364 60.0 63.6 65.1 44.9
Centre Slovakia 58 82.9 21 36.2 27 46.6 45.5 – 45.7
Centre Slovenia 33 84.6 12 36.4 15 45.5 44.4 – 47.8
West Spain 2 726 84.1 749 27.5 1 307 47.9 57.8 51.9 41.5
West Sweden 326 77.4 85 26.1 153 46.9 58.9 31.3 30.4
West United Kingdom 3 460 79.8 737 21.3 1 424 41.2 52.4 48.9 31.0
Total EU/EEA 16 585 71.7 4 690 28.3 8 055 48.6 57.6 51.2 38.9
Non-EU/EEA
Centre Albania 58 62.4 25 43.1 34 58.6 60.0 – –
West Andorra – – – – – – – – –
East Armenia 281 80.7 104 37.0 154 54.8 54.3 66.7 35.7
East Azerbaijan 229 41.2 78 34.1 119 52.0 49.7 75.9 16.7
East Belarus – – – – – – – – –
Centre Bosnia and Herzegovina 4 33.3 2 50.0 2 50.0 – – –
East Georgia 546 87.1 187 34.2 285 52.2 56.8 63.3 29.3
West Israel 231 57.9 57 24.7 108 46.8 59.8 42.9 35.2
East Kazakhstan 2 206 74.1 444 20.1 1 007 45.6 49.0 39.1 42.4
East Kyrgyzstan 351 43.3 120 34.2 237 67.5 70.1 63.4 60.0
West Monaco – – – – – – – – –
Centre Montenegro 26 100.0 12 46.2 16 61.5 – – 54.5
East Republic of Moldova 638 77.3 191 29.9 340 53.3 52.2 52.6 57.1
East Russian Federation – – – – – – – – –
West San Marino – – – – – – – – –
Centre Serbia 125 69.1 58 46.4 82 65.6 66.7 – 63.1
Centre Serbia excluding Kosovoe 123 69.1 57 46.3 81 65.9 68.8 – 63.1
Centre Kosovoe 2 66.7 1 50.0 1 50.0 – – –
West Switzerland 301 68.7 83 27.6 142 47.2 56.2 50.0 38.3
East Tajikistan 918 84.7 342 37.3 574 62.5 62.0 63.4 66.7
The former Yugoslav Republic
Centre 34 79.1 7 20.6 13 38.2 – – 34.5
of Macedonia
Centre Turkey – – – – – – – – –
East Turkmenistan – – – – – – – – –
East Ukraine 13 908 89.3 5 194 37.3 8 172 58.8 59.8 57.9 43.0
East Uzbekistan – – – – – – – – –
Total non-EU/EEA 19 856 82.7 6 904 34.8 11 285 56.8 58.4 55.7 42.3
WHO European Region
West 15 433 71.1 4 276 27.7 7 403 48.0 57.1 52.0 38.5
Centre 1 536 85.8 517 33.7 806 52.5 61.3 58.7 43.2
East 19 472 82.3 6 801 34.9 11 131 57.2 58.5 55.4 43.2
Total WHO European Region 36 441 77.3 11 594 31.8 19 340 53.1 58.2 55.2 39.4
a
Country-specific comments are in Annex 5.
b
T here is some variation by country, territory or area for CD4 cell count completeness by transmission group and numbers of cases by transmission group (MSM,
heterosexual, injecting drug users), so percentages based on five or fewer cases are censored.
c
Due to technical problems no data export for 2017 from Germany was available.
d
People who were previously diagnosed HIV positive abroad are excluded in numbers reported for Denmark and Ireland and the data presented in the table are
therefore not comparable with other countries. 83
e
( in accordance with Security Council resolution 1244 (1999)).
HIV/AIDS surveillance in Europe 2018 – 2017 data SURVEILLANCE REPORT
Table 15. AIDS diagnoses and rates per 100 000 population, by country and year of diagnosis (2008–2017) and
cumulative totals, in EU/EEA and other countries of the WHO European Region
84
SURVEILLANCE REPORT HIV/AIDS surveillance in Europe 2018 – 2017 data
85
HIV/AIDS surveillance in Europe 2018 – 2017 data SURVEILLANCE REPORT
Table 16. AIDS diagnoses in males and rates per 100 000 population, by country and year of diagnosis (2008–2017) and
cumulative totals, in EU/EEA and other countries of the WHO European Region
86
SURVEILLANCE REPORT HIV/AIDS surveillance in Europe 2018 – 2017 data
87
HIV/AIDS surveillance in Europe 2018 – 2017 data SURVEILLANCE REPORT
Table 17. AIDS diagnoses in females and rates per 100 000 population, by country and year of diagnosis (2008–2017)
and cumulative totals, in EU/EEA and other countries of the WHO European Region
88
SURVEILLANCE REPORT HIV/AIDS surveillance in Europe 2018 – 2017 data
89
HIV/AIDS surveillance in Europe 2018 – 2017 data SURVEILLANCE REPORT
Table 18. AIDS diagnoses in men infected through sex with men, by country and year of diagnosis (2008–2017) and
cumulative totals, in EU/EEA and other countries of the WHO European Region
90
SURVEILLANCE REPORT HIV/AIDS surveillance in Europe 2018 – 2017 data
Table 19. AIDS diagnoses in people infected through injecting drug use, by country and year of diagnosis (2008–2017)
and cumulative totals, in EU/EEA and other countries of the WHO European Region
91
HIV/AIDS surveillance in Europe 2018 – 2017 data SURVEILLANCE REPORT
Table 20. AIDS diagnoses in people infected through heterosexual contact, by country and year of diagnosis
(2008–2017) and cumulative totals, in EU/EEA and other countries of the WHO European Region
92
SURVEILLANCE REPORT HIV/AIDS surveillance in Europe 2018 – 2017 data
Table 21. AIDS diagnoses in people infected through mother-to-child transmission, by country and year of diagnosis
(2008–2017) and cumulative totals, in EU/EEA and other countries of the WHO European Region
93
HIV/AIDS surveillance in Europe 2018 – 2017 data SURVEILLANCE REPORT
Table 22. AIDS diagnoses in 2017, by country of report, transmission mode and sex, in EU/EEA and other countries of
the WHO European Region
94
SURVEILLANCE REPORT HIV/AIDS surveillance in Europe 2018 – 2017 data
95
HIV/AIDS surveillance in Europe 2018 – 2017 data SURVEILLANCE REPORT
Table 23. The most common AIDS-indicative diseases diagnosed in 2017,a ordered by frequency
96
SURVEILLANCE REPORT HIV/AIDS surveillance in Europe 2018 – 2017 data
Table 24. AIDS-related deaths,a by geographic area, country and year of death (2008–2017) and cumulative totals in
EU/EEA and other countries of the WHO European Region
Table 25. AIDS-related deaths,a by sex, transmission mode and year of death (2008–2017) and cumulative totalsb
98
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99
HIV/AIDS surveillance in Europe 2018 – 2017 data SURVEILLANCE REPORT
Table 25. AIDS-related deaths,a by sex, transmission mode and year of death (2008–2017) and cumulative totalsb
100
SURVEILLANCE REPORT HIV/AIDS surveillance in Europe 2018 – 2017 data
101
HIV/AIDS surveillance in Europe 2018 – 2017 data SURVEILLANCE REPORT
Table 26. Number of HIV tests performed, excluding unlinked anonymous testing and testing of blood donations, by
country and year (2008–2017) and number of tests per 1000 population in 2017, in EU/EEA and other countries of the
WHO European Region
102
Maps
HIV/AIDS surveillance in Europe 2018 – 2017 data SURVEILLANCE REPORT
<2
2 to < 5
5 to < 10
10 to < 20
20 to < 50
≥ 50
Missing or excluded data
Andorra
Luxembourg
Malta
Monaco
San Marino
Note: all data presented were reported to ECDC/WHO through the European Surveillance System (TESSy), except for data for the Russian Federation (source for data
from the Russian Federation: Information note ‘Spravka’ on HIV infection in the Russian Federation as of 31 December 2017. Moscow: Russian Federal Scientific and
Methodological Centre for Prevention and Control of AIDS; 2018).
Map 2. New HIV diagnoses in men per 100 000 male population, 2017
<2
2 to < 5
5 to < 10
10 to < 20
20 to < 50
≥ 50
Missing or excluded data
Andorra
Luxembourg
Malta
Monaco
San Marino
104
SURVEILLANCE REPORT HIV/AIDS surveillance in Europe 2018 – 2017 data
Map 3. New HIV diagnoses in women per 100 000 female population, 2017
<2
2 to < 5
5 to < 10
10 to < 20
20 to < 50
≥ 50
Missing or excluded data
Andorra
Luxembourg
Malta
Monaco
San Marino
Map 4. New HIV diagnoses in men who have sex with men per 100 000 male population, 2017
<1
1 to < 3
3 to < 5
≥5
Missing or excluded data
Andorra
Luxembourg
Malta
Monaco
San Marino
105
HIV/AIDS surveillance in Europe 2018 – 2017 data SURVEILLANCE REPORT
Map 5. New HIV diagnoses acquired through injecting drug use per 100 000 population, 2017
<1
1 to < 3
3 to < 5
≥5
Missing or excluded data
Andorra
Luxembourg
Malta
Monaco
San Marino
Map 6. New HIV diagnoses acquired through heterosexual transmission per 100 000 population, 2017
<1
1 to < 3
3 to < 5
≥5
Missing or excluded data
Andorra
Luxembourg
Malta
Monaco
San Marino
106
SURVEILLANCE REPORT HIV/AIDS surveillance in Europe 2018 – 2017 data
Map 7. Percentage of adult (> 14 years) HIV diagnoses with CD4 < 350 cells/mm3 at diagnosis, 2017
Andorra
Luxembourg
Malta
Monaco
San Marino
<1
1 to < 3
3 to < 5
≥5
Missing or excluded data
Andorra
Luxembourg
Malta
Monaco
San Marino
107
Annexes
SURVEILLANCE REPORT HIV/AIDS surveillance in Europe 2018 – 2017 data
111
HIV/AIDS surveillance in Europe 2018 – 2017 data SURVEILLANCE REPORT
Reporting of aggregated HIV and AIDS data has an using historical data from 2006 to 2016. Countries were
impact on the data presentation and analysis and the excluded from reporting delay adjustment when:
epidemiological overview of HIV/AIDS in Europe because
• they showed an inconsistent and non-stationary pat-
fewer variables are available from the aggregated data-
tern in their reporting delay distribution during the
sets, reducing the amount of data that can be presented
period 2008–2017; or
in certain tables and figures.
• they reported aggregated data during the period
Data re-coding and adjustments 2008–2017.
Dates used for data presentation Adjusting for reporting delay can help to indicate HIV
trends in recent years more precisely. Adjustments also
HIV and AIDS data are presented in this report by date provide insight into the timeliness of data collection and
of diagnosis. If countries could not provide this date or reporting from subnational to national and European
preferred to present their data by the date of statistics levels.
to avoid discrepancies with their national surveillance
reports, this date was used instead. This was the Adjustment for reporting delays was applied to the
case for eight countries: Azerbaijan, Belarus, Georgia, graphs showing trends where noted. The list of coun-
Kazakhstan, Kyrgyzstan, Turkey, Tajikistan and Ukraine. tries with the number of reported diagnoses adjusted
for reporting delay are presented in Annex 6.
Region of origin
Where available, countries were encouraged to provide Data presentation
data on the specific country of origin or nationality of
the case. This information was used first and, if absent,
Geographical presentation
the variable “region of origin” was used to group cases Data are presented for the WHO European Region and
into region of origin, presented in Table 11 (stratified by the EU/EEA. The EU comprises 28 Member States and the
reporting country) and Table 12 (all countries stratified EEA comprises an additional three countries (Iceland,
by mode of transmission). Liechtenstein and Norway) which are included in the
overview of the EU/EEA.
Origin of reported cases
The tables are presented for EU/EEA countries, non-
Cases originating from countries outside of the report-
EU/EEA countries and as totals. The 53 countries of the
ing country, including those from outside of Europe or
WHO European Region are also subdivided into three
from countries with generalized HIV epidemics, are
geographical areas, based on epidemiological consid-
occasionally separated from other cases for the analy-
erations and in accordance with the division used in
ses presented here. This approach has been taken to
previous reports on HIV/AIDS surveillance in Europe:
inform epidemiological understanding and guide public
West (23 countries), Centre (15 countries) and East (15
health resource allocation and prevention efforts. To
countries) (Fig. A1.1). The division reflects similarities
compare the impact of the epidemic on all transmission
in epidemiological dynamics such as epidemic levels,
modes, cases reported as originating from regions or
trends over time and transmission patterns. Of the
countries of sub-Saharan Africa were used as a proxy for
EU/EEA countries, 19 Member States are classified as
countries with generalized HIV epidemics (in Tables 11,
being in the West, nine in the Centre and three in the
12 and in selected figures). As most of the cases origi-
East.
nating from sub-Saharan Africa were reported from west
European countries within the EU/EEA, this information Liechtenstein is not a WHO Member State so its data are
is presented in detail in Chapter 1. included in the totals for the EU/EEA but not for the WHO
European Region. Totals for West, Centre and East there-
Reporting delay fore may not always equal the EU/EEA and non-EU/EEA
Reporting delays refer to the time delay between HIV/ totals. Data from Serbia include HIV cases notified in
AIDS diagnosis and the report of this event at national Kosovo1 in all figures while these are stratified in tables
level, identified by date of notification. Due to delays to allow separate epidemiological presentation of the
in reporting, HIV trends analysed at European level are reported data.
often biased downwards for the most recent year (2017)
and, to a lesser extent, for the two to three years prior Population data and rates
to the reporting period. To provide a more precise pic- Data are presented in absolute numbers and rates as
ture of trends, surveillance data should be corrected to cases per 100 000 population.
describe the trends in HIV diagnoses more accurately.
The population estimates up to 2017 were derived from
This report applies a statistical approach, as described Eurostat for all EU/EEA countries and from the United
by Heisterkamp et al. (3) and adapted by Rosinska et al. Nations Population Division for non-EU/EEA countries (5).
(4), to adjust the surveillance data for reporting delays.
Annual reporting delay probabilities were estimated 1 For the purposes of this publication, all references, including in the
bibliography, to “Kosovo” should be understood/read as “Kosovo (in
accordance with Security Council resolution 1244 (1999))”.
112
SURVEILLANCE REPORT HIV/AIDS surveillance in Europe 2018 – 2017 data
West
Centre
East
Andorra
Luxembourg
Malta
Monaco
San Marino
The Eurostat data are from 10 August 2017 (6) and the Trend data
United Nations population data from August 2017.
Only countries reporting consistently were included for
The population data used for HIV and AIDS in Spain and presentation of the overall trends; these are noted in the
for HIV in Italy were adjusted according to the extent of footnotes to the trend graphs.
subnational coverage for the relevant years. The popula-
tion data used for Ukraine were adjusted to exclude the When presenting HIV trends for 2008–2017 by trans-
areas from which no surveillance data were reported in mission mode, countries reporting transmission mode
2014–2017 (7). inconsistently or incompletely (such as Estonia, Poland
and Turkey) were excluded from relevant figures report-
Rates for data presented by gender and age were cal- ing trends by transmission mode. Countries with varying
culated using relevant male and female population geographic coverage of the national surveillance system
denominators from the sources described above. For over time (Spain and Italy) or that did not report for part
maps presenting figures for men who have sex with of the period (Germany) were also excluded from graphs
men, rates were calculated using the male population. showing HIV trends.
Data are presented by year but also as cumulative totals When presenting trends for AIDS deaths, only countries
per country. The cumulative total includes all data reporting consistently were included (Belgium, Germany,
reported by that particular country since the beginning Italy, the Russian Federation, Sweden, Turkmenistan,
of national reporting and is not limited to the selected Ukraine and Uzbekistan were not included in the pres-
number of years presented. entation of trends for AIDS deaths in Table 25 or the
description in the text).
113
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114
SURVEILLANCE REPORT HIV/AIDS surveillance in Europe 2018 – 2017 data
Annex 2
Completeness of variables for data reported in 2016 and 2017
2016 2017
Number of Completeness Number of Completeness
Minimal Maximal Minimal Maximal
countries % countries %
EU/EEA Countries
Age 31 99.7 86.0 100.0 29 99.6 74.9 100.0
Gender 31 99.6 84.2 100.0 29 99.4 74.4 100.0
Date of diagnosis 31 100.0 100.0 100.0 29 100.0 100.0 100.0
Date of notification 29 84.8 80.9 100.0 27 84.1 80.2 100.0
Transmission 31 79.1 41.7 100.0 29 75.8 33.5 100.0
Date of AIDS diagnosis 29 30.4 2.5 100.0 26 24.9 3.3 83.2
Date of death 25 1.7 0.4 100.0 23 1.5 0.4 8.0
Country of birth 25 58.0 2.3 100.0 23 52.1 34.7 100.0
Region of origin 25 81.4 59.6 100.0 24 77.5 50.2 100.0
CD4 cell counta 26 64.6 22.9 97.4 25 66.3 35.6 96.7
Probable country of infection 24 31.8 2.8 100.0 23 33.8 0.2 99.2
WHO European Region
Age 52 99.8 50.0 100.0 51 99.8 74.9 100.0
Gender 52 99.8 84.2 100.0 51 99.7 74.4 100.0
Date of diagnosis 52 100.0 100.0 100.0 51 100.0 100.0 100.0
Date of notification 49 91.9 80.9 100.0 48 92.7 80.2 100.0
Transmission 51 85.2 41.7 100.0 50 84.6 33.5 100.0
Date of AIDS 47 28.0 2.5 100.0 44 25.3 3.2 100.0
Date of death 43 9.3 0.4 100.0 40 5.1 0.4 99.3
Country of birth 43 52.1 2.3 100.0 41 47.8 34.7 100.0
Region of origin 45 89.4 50.0 100.0 43 88.6 50.2 100.0
CD4 cell counta 46 67.8 4.3 97.4 42 67.2 33.3 100.0
Probable country of infection 36 32.0 2.8 100.0 38 35.6 0.2 100.0
a
D4 completeness is calculated on all new diagnoses; Table 14 (see Tables section) completeness calculations are restricted to new diagnoses in countries reporting
C
the variables CD4Cells or FirstCD4Count.
115
HIV/AIDS surveillance in Europe 2018 – 2017 data SURVEILLANCE REPORT
Annex 3
Completeness by country and variable, 2017
Date of Date of
Area Country, territory or areaa Age Gender Transmission CD4 cell count Country of birthb
diagnosis notification
EU/EEA
West Austria 100.0 100.0 100.0 100.0 92.6 96.7 99.6
West Belgium 100.0 100.0 99.7 100.0 71.0 67.8 77.0
Centre Bulgaria 100.0 100.0 100.0 100.0 100.0 77.2 100.0
Centre Croatia 100.0 100.0 100.0 100.0 99.1 96.2 100.0
Centre Cyprus 100.0 100.0 100.0 100.0 96.5 88.2 100.0
Centre Czech Republic 100.0 100.0 100.0 100.0 97.2 90.9 100.0
West Denmark 100.0 100.0 100.0 100.0 94.2 54.1 100.0
East Estonia 100.0 100.0 100.0 100.0 54.3 35.6 50.2
West Finland 100.0 100.0 100.0 100.0 72.2 79.1 89.2
West France 100.0 100.0 100.0 100.0 52.6 45.7 56.6
West Germany – – – – – – –
West Greece 100.0 99.5 100.0 100.0 82.5 68.8 97.8
Centre Hungary 100.0 100.0 74.9 99.7 60.5 0.0 0.0
West Iceland 100.0 100.0 100.0 100.0 37.5 0.0 100.0
West Ireland 100.0 100.0 100.0 100.0 84.1 64.2 81.4
West Italy 100.0 80.2 100.0 100.0 87.5 78.7 99.6
East Latvia 100.0 100.0 100.0 100.0 63.6 57.7 99.5
Liechtenstein – – – – – – –
East Lithuania 100.0 100.0 100.0 100.0 83.7 39.9 100.0
West Luxembourg 100.0 100.0 100.0 100.0 91.5 78.0 100.0
West Malta 100.0 100.0 93.3 100.0 88.9 73.3 100.0
West Netherlands 100.0 100.0 100.0 100.0 89.2 89.0 95.7
West Norway 100.0 100.0 100.0 100.0 99.5 0.0 93.4
Centre Poland 100.0 100.0 97.4 100.0 33.5 0.0 61.9
West Portugal 100.0 100.0 100.0 100.0 96.0 84.7 96.8
Centre Romania 100.0 100.0 100.0 100.0 99.8 94.3 99.2
Centre Slovakia 100.0 100.0 100.0 100.0 92.9 82.9 100.0
Centre Slovenia 100.0 100.0 100.0 100.0 92.3 84.6 92.3
West Spain 100.0 0.0 100.0 100.0 85.9 84.0 96.5
West Sweden 100.0 100.0 100.0 100.0 87.1 77.6 97.5
West United Kingdom 100.0 100.0 100.0 100.0 82.3 79.5 88.2
Non-EU/EEA
Centre Albania 100.0 100.0 100.0 100.0 100.0 61.7 100.0
West Andorra 100.0 100.0 – – – – –
East Armenia 100.0 100.0 100.0 100.0 96.3 80.5 100.0
East Azerbaijan 100.0 100.0 100.0 100.0 82.3 41.4 100.0
East Belarus 100.0 100.0 100.0 100.0 98.8 0.0 100.0
Centre Bosnia and Herzegovina 100.0 100.0 100.0 100.0 100.0 33.3 100.0
East Georgia 100.0 100.0 99.8 100.0 99.4 87.0 100.0
West Israel 100.0 100.0 99.5 100.0 86.4 57.5 100.0
East Kazakhstan 100.0 100.0 100.0 100.0 97.5 74.3 100.0
East Kyrgyzstan 100.0 100.0 100.0 100.0 91.4 44.0 100.0
West Monaco – – – – – – –
Centre Montenegro 100.0 100.0 100.0 100.0 100.0 100.0 100.0
East Republic of Moldova 100.0 100.0 100.0 100.0 76.9 77.5 100.0
East Russian Federation – – – – – – –
West San Marino – – – – – – –
Centre Serbia 100.0 100.0 100.0 100.0 84.5 69.1 100.0
Centre Serbia excluding Kosovoc 100.0 100.0 100.0 100.0 84.8 69.1 100.0
Centre Kosovoc – – – – – – –
West Switzerland 100.0 100.0 99.6 100.0 73.1 68.4 81.0
East Tajikistan 100.0 100.0 100.0 100.0 91.0 85.3 100.0
Centre The former Yugoslav Republic 100.0 100.0 97.7 100.0 95.5 77.3 100.0
of Macedonia
Centre Turkey 100.0 100.0 100.0 100.0 46.0 0.0 97.1
East Turkmenistan – – – – – – –
East Ukraine 100.0 100.0 100.0 100.0 99.8 89.2 100.0
East Uzbekistan – – – – – – –
a
ompleteness not computed on countries, territories or areas with fewer than five diagnoses reported in 2017 (Liechtenstein, Monaco and San Marino, and Kosovoc).
C
b
Completeness provided is based on country of birth, region of origin or, for Italy and Switzerland, country of nationality.
c
( in accordance with Security Council resolution 1244 (1999)).
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SURVEILLANCE REPORT HIV/AIDS surveillance in Europe 2018 – 2017 data
Annex 4a
HIV surveillance system overview: data source information
Recorda
type for
Country HIV data source Period Legalb Coveragec Comments
2017
reporting
EU/EEA
Austria AT-HIV HIVAIDS 1980–2017 V Co
Belgium BE-HIV/AIDS HIVAIDS 1978–2017 V Co
Bulgaria BG-HIV HIVAIDS 1986–2017 C Co HIV aggregate record type used through 2006; HIV record type
2007–2013
Cyprus CY-HIV/AIDS HIVAIDS 1986–2017 C Co
Croatia HR-CNIPH HIVAIDS 1985–2017 C Co HIV record type used prior to 2016
Czech Republic CZ-HIV/AIDS HIVAIDS 1985–2017 C Co
Denmark DK-HIV HIVAIDS 1990–2017 C Co HIV record type used 1990–2013
Estonia EE-NAKIS HIVAIDS 1988–2017 C Co Data source EE-HIV used 1988–2012; HIV aggregate record type used
through 2006; HIV record type prior to 2015
Finland FI-NIDR HIVAIDS 1980–2017 C Co HIV record type used prior to 2016
France FR-HIVAIDS HIVAIDS 2003–2017 C Co Although compulsory, HIV diagnoses are not exhaustively reported;
underreporting was estimated at 30% in 2014
Germany DE-SURVNET@RKI7.3-HIV 1993–2016 C Co Data source DE-HIV-Pre-IfSG used 1993–2001; HIV recordtype used to
report data up to 2016
Greece EL-HIV/AIDS HIVAIDS 1981–2017 C Co
Hungary HU-HIV/AIDS HIVAIDS 1985–2017 C Co
Iceland IS-SUBJECT_TO_REGISTRATION HIVAIDS 1983–2017 C Co HIV record type used prior to 2017
Ireland IE-CIDR HIVAIDS 1981–2017 C Co Data source IE-HIV/AIDS used for years 1981–2011; HIV aggregate
used for reporting through 2002; HIV record type 2003–2011
Italy IT-COA-ISS HIV 2004–2017 C Co See country comments about historical coverage; HIV aggregate
record type used through 2009
Latvia LV-HIV/AIDS HIVAIDS 1987–2017 C Co HIV record type used 1987–2013; HIVAIDS record type used from 2014
Liechtenstein CH-SFOPH-LI HIV 1985–2017 V NS/unk Cases reported through Switzerland's surveillance system using
another data source
Lithuania LT-AIDS_CENTRE HIVAIDS 1988–2017 C Co
Luxembourg LU-HIVAIDS HIVAIDS 1983–2017 V Co
Malta MT-DISEASE_SURVEILLANCE HIVAIDS 1986–2017 C Co HIV record type used in years 1986–2014
Netherlands NL-HIV/AIDS HIVAIDS 1980–2017 V Co
Norway NO-MSIS_B HIVAIDS 1980–2017 C Co HIV record type used in years 1980–2013
Poland PL-HIV HIVAIDS 1984–2017 C Co
Portugal PT-HIVAIDS HIVAIDS 1983–2017 C Co
Romania RO-RSS HIVAIDS 1985–2017 C Co
Slovakia SK-EPIS HIVAIDS 1985–2017 C Co HIV record type used in years 1985–2013
Slovenia SI-HIVAIDS HIVAIDS 1985–2017 C Co
Spain ES-HIV HIV 2003–2017 C Co See country comments about historical coverage
Sweden SE-SmiNet HIVAIDS 1983–2017 C Co Data source SE-SweHIVReg used 1983–2009; HIV record type used
prior to 2014
United Kingdom UK-HIVAIDS HIVAIDS 1981–2017 V Co
Non-EU/EEA
Albania AL-NIoPH HIVAIDS 1993–2017 C Co
Andorra AD-MoHWFH HIVAIDS 2004–2017 V Co
Armenia AM-NAC HIVAIDS 1988–2017 V Co
Azerbaijan AZ-AIDS-CENTER-NEW HIVAIDS 1987–2017 V Se
Belarus BY-NAC HIVAIDS 1981–2017 C Co HIVAIDS record type used only for HIV reporting (no linked HIV and
AIDS reporting); HIV record type used in years 1981–2013
Bosnia and Herzegovina BA-FMoH-MoHSWRS HIVAIDS 1986–2017 C Co HIV record type used in years 1993–2013
Georgia GE-IDACIRC HIVAIDS 1989–2017 C Co
Israel IL-MOH HIVAIDS 1981–2017 C Co
Kazakhstan KZ-RCfAPC HIVAIDS 1987–2017 NS/ NS/unk
unk
Kyrgyzstan KG-HIV KG 2008 HIVAIDS 1987–2017 V Co HIV record type used in years 1987–2000
Montenegro ME-IOPH HIVAIDS 1989–2017 C Co
Monaco MC-MoSH-GEN HIV 1985–2017 C Co
Republic of Moldova MD-NAC HIVAIDS 1987–2017 V Other
Russian Federation RU-MOH - 2010 C Co
San Marino SM-AIDS/HIV HIVAGGR 1985–2017 C Co
Serbiad RS-NAC HIVAIDS 1984–2017 C Co HIV aggregate record type used in years 1984–2001
Switzerland CH-FOPH HIV 1985–2017 C Co
Tajikistan TJ-RHAC HIVAIDS 1991–2017 C Co
The former Yugoslav MK-NHASS HIVAIDS 1993–2017 C Co HIV record type used in years 1993–2016
Republic of Macedonia
Turkey TR-MOH HIV 1984–2017 C Co
Turkmenistan TM-NAC - 1981–2012 V Co
Ukraine UA-NAC HIVAIDS 1987–2017 V Other HIVAIDS record type used only for HIV reporting (no linked HIV and
AIDS reporting); HIVAGGR record type used in years 1987–2015.
Uzbekistan UZ-RAC - 1981–2010 V Co Did not report data 2011–2017; used HIV record type in years
1981–2010
a
Type: HIVAIDS (HIV and AIDS joined case-based record type); HIV (HIV case-based record type); AIDS (AIDS case-based record type); HIVAGGR (HIV aggregate record
type); AIDSAGGR (AIDS aggregate record type).
b
Legal: voluntary reporting (V); compulsory reporting (C); not-specified/unknown (NS/unk).
c
Coverage: sentinel system (Se); comprehensive (Co); not-specified/unknown (NS/unk).
117
d
HIV data from Kosovo (in accordance with Security Council resolution 1244 (1999)) were reported through data source XK-HIVAIDS for 1986–2017;
HIVAIDS record type used for all years.
HIV/AIDS surveillance in Europe 2018 – 2017 data SURVEILLANCE REPORT
Annex 4b
AIDS surveillance system overview: data source information
Recorda
type for
Country HIV data source Period Legalb Coveragec Comments
2017
reporting
EU/EEA
Austria AT-AIDS HIVAIDS 1980-2017 V Co
Belgium BE-HIV/AIDS 1978-2015 V Co Did not report 2016 or 2017 data
Bulgaria BG-AIDS HIVAIDS 1986-2017 C Co AIDS record type was used for cases prior to 2014
Cyprus CY-HIV/AIDS HIVAIDS 1986-2017 C Co
Croatia HR-CNIPH HIVAIDS 1985-2017 C Co AIDS record type used prior to 2016
Czech Republic CZ-HIV/AIDS HIVAIDS 1985-2017 C Co
Denmark DK-HIV HIVAIDS 1980-2017 C Co AIDS record type from data source DK-MIS used 1980-2013
Estonia EE-NAKIS HIVAIDS 1988-2017 C Co AIDS record type used prior to 2015
Finland FI-NIDR AIDS 1980-2017 C Co AIDS record type used prior to 2016
France FR-HIVAIDS; FR-AIDS HIVAIDS 2003-2017 C Co Additional data from record type AIDS used for the years 1978-2016
Although compulsory, AIDS diagnoses are not exhaustively reported.
Underreporting was estimated 41% in 2007-2009
Germany DE-AIDS 1970-2016 V Co Did not report 2017 data, AIDS record type used through 2016
Greece EL-HIV/AIDS HIVAIDS 1981-2017 C Co
Hungary HU-HIV/AIDS HIVAIDS 1985-2017 C Co
Iceland IS-SUBJECT_TO_REGISTRATION HIVAIDS 1983-2017 C Co
Ireland IE-CIDR HIVAIDS 1981-2017 V Co Data source IE-HIV/AIDS and AIDS record type used for years
1981-2011
Italy IT-COA-ISS AIDS 1982-2017 C Co
Latvia LV-AIDS HIVAIDS 1990-2017 C Co Same data source in AIDS record type used for 1990-2013
Liechtenstein CH-SFOPH-LI AIDS 1985-2017 V NS/unk Cases reported through Switzerland's surveillance system
Lithuania LT-AIDS_CENTRE HIVAIDS 1988-2017 C Co
Luxembourg LU-HIVAIDS HIVAIDS 1983-2017 V Co
Malta MT-DISEASE_SURVEILLANCE HIVAIDS 1986-2017 C Co Same data source and AIDS record type used 1986-2014
Netherlands NL-HIV/AIDS HIVAIDS 1980-2017 V Co
Norway NO-MSIS_B HIVAIDS 1980-2017 C Co Data source NO-MSIS-A and record type AIDS used in years
1980-2013
Poland PL-HIV HIVAIDS 1984-2017 C Co
Portugal PT-HIVAIDS HIVAIDS 1983-2017 C Co
Romania RO-RSS HIVAIDS 1985-2017 C Co
Slovakia SK-EPIS HIVAIDS 1985-2017 C Co AIDS record type used in years 1985-2013
Slovenia SI-HIVAIDS HIVAIDS 1985-2017 C Co
Spain ES-AIDS AIDS 1981-2017 C Co See country comments about coverage
Sweden 1983-2007 V Co AIDS surveillance discontinued in 2008
United Kingdom UK-HIVAIDS HIVAIDS 1981-2017 V Co
Non-EU/EEA
Albania AL-NIoPH HIVAIDS 1993-2017 C Co
Andorra AD-MoHWFH HIVAIDS 2004-2017 V Co
Armenia AM-NAC HIVAIDS 1988-2017 V Se
Azerbaijan AZ-AIDS-CENTER-NEW HIVAIDS 1995-2017 V Co
Belarus BY-NAC AIDS 1991-2017 C Co
Bosnia and Herzegovina BA-FMoH-MoHSWRS HIVAIDS 1986-2017 C Co AIDS record type used in years 1986–2013
Georgia GE-IDACIRC HIVAIDS 1989-2017 C Co
Israel IL-MOH HIVAIDS 1981-2017 C Co
Kazakhstan KZ-RCfAPC HIVAIDS 1993-2017 NS NS
Kyrgyzstan KG-HIV KG 2008 HIVAIDS 1999-2017 V Co AIDS record type used in years 1987-2000
Montenegro ME-IOPH HIVAIDS 1990-2017 C Co
Monaco MC-MoSH-GEN HIV 1985-2017 C Co
Republic of Moldova MD-NAC HIVAIDS 1989-2017 V Co
Russian Federation - - - - -
San Marino SM-AIDS/HIV AIDS 1986-2017 C Co
Serbiad RS-NAC HIVAIDS 1985-2017 C Co AIDS record type used in years 1985-2001
Switzerland CH-FOPH AIDS 1980-2017 C Co
Tajikistan TJ-RHAC HIVAIDS 1998-2017 C Co
The former Yugoslav MK-NHASS HIVAIDS 1989-2017 C Co AIDS record type used in years 1993–2016
Republic of Macedonia
Turkey TR-MOH AIDS 1985-2017 C Co
Turkmenistan TM-NAC - 2002-2012 V Co
Ukraine UA-NAC AIDSAGGR 1988-2017 V Co HIVAIDS record type used only for HIV reporting (i.e. no linked HIV
and AIDS reporting).
Uzbekistan UZ-RAC - 1992-2010 V Co Did not report data 2011-2017; used AIDS record type in years
1992-2010
a
Type: HIVAIDS (HIV and AIDS joined case-based record type); HIV (HIV case-based record type); AIDS (AIDS case-based record type); HIVAGGR (HIV aggregate record
type); AIDSAGGR (AIDS aggregate record type).
b
L egal: voluntary reporting (V); compulsory reporting (C); not-specified/unknown (NS/unk).
c
Coverage: sentinel system (Se); comprehensive (Co); not-specified/unknown (NS/unk).
d
HIV data from Kosovo (in accordance with Security Council resolution 1244 (1999)) were reported through data source XK-HIVAIDS for 1986–2017; HIVAIDS record
type used for all years.
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SURVEILLANCE REPORT HIV/AIDS surveillance in Europe 2018 – 2017 data
Annex 5
Country-specific comments regarding national HIV and AIDS reporting
Country Comments
EU/EEA
Austria
Belgium Due to a temporary data merger issue, information on AIDS diagnoses for 2016 and 2017 were not available but will be reported to TESSy in the future.
Bulgaria Case-based reporting of HIV is available from 2007 onwards.
Croatia
Cyprus Population rates presented in this report may differ slightly from rates presented in the national report due to the use of different Eurostat population
extracts.
Czech Republic Foreigners with short-term stays in the Czech Republic are not included in cases notified.
Denmark
Estonia The surveillance system was modified substantially in 2008. Previously, the probable mode of HIV transmission was not reported by Estonia (from 2003
to 2007, Estonia supplied partial information on people who inject drugs only).
Finland
France Case-based data reported through TESSy are not exhaustive because of reporting delays (cases reported several months or years after the diagnosis)
and underreporting (cases that are diagnosed but never reported). The most recent estimates of underreporting in France are 41% in 2007–2009 for AIDS
and 30% in 2015 for HIV. To assess the real numbers and trends of HIV and AIDS diagnoses in France, it is essential to use adjusted data, which take into
account reporting delays, underreporting and missing data (incomplete reports). Adjusted data for 2017 was not available at the time of the production
of this report. The French HIV/AIDS reporting system was changed in 2016 to report AIDS and HIV diagnoses online, and physicians should report HIV
diagnoses spontaneously, without waiting for the laboratory report. The use of this new tool by laboratories and physicians has increased over time, but
clinicians are less compliant than laboratories. In 2016–2017, thererfore, the proportion of missing data on variables (such as route of transmission) is
increased.
Germany Due to technical problems, no data export for 2017 HIV or AIDS data was possible. These data will be reported when available and included in future
reports.
Greece
Hungary
Iceland
Ireland HIV was made a notifiable disease in September 2011. The HIV reporting system was modified substantially in 2012. AIDS cases and deaths among
AIDS cases are now only reported if at the time of HIV diagnosis. HIV diagnoses include a growing proportion of "previous-positive" people, who are
transferring their HIV care when moving to Ireland and tested positive and notified within the Irish system when moving to the country. There was a
change in the implementation of the case definition in 2015 (requiring confirmatory testing on a single sample rather than two samples) which resulted in
more people being notified to the surveillance system.
Italy New HIV diagnoses were reported by 10 of the 21 Italian regions between 2004 and 2006, 11 regions in 2007, 12 in 2008, 18 in 2009, and all of the 21
regions of Italy since 2012. Between 2004 and 2011, population denominators are based on the annual resident population in the regions reporting cases.
From 2012, the coverage of the surveillance system is national, so the total Italian population is used as a denominator. AIDS deaths are not reported
after 2014 due to lack of updated data from the national mortality register.
Latvia Population rates presented in this report may differ slightly from rates presented in the national report due to the use of different Eurostat population
extracts.
Liechtenstein Liechtenstein, with only 35 000 inhabitants, has small numbers of communicable diseases. Public health authorities therefore refrain from collecting
data due limited public health added value. In 1970, Liechtenstein adopted the Swiss Law of Epidemiology. Since then, all communicable disease data are
reported to officials in Switzerland, as demanded by the Federal Office of Public Health. These data are reported through Switzerland to TESSy but may
not represent all cases diagnosed in Liechtenstein.
Lithuania
Luxembourg HIV tests reported through 2010 include only tests performed at two major public laboratories, so underestimate the total number of HIV tests performed
during those years. From 2011, tests reported include all laboratories in the country.
Malta A new HIV reporting system started in 2004.
Netherlands HIV surveillance is based on the ATHENA cohort, which includes 98% of people who entered HIV care in the Netherlands. Data collection started from 1996
onwards and HIV diagnoses before 1996 are incomplete.
Norway
Poland
Portugal The PT-HIV database is now fully case-based, containing details of cases diagnosed from 1983. In 2013 and 2014, the Portuguese HIV/AIDS programme
implemented a strategy to address underreporting and reporting delay, resulting in significant increases of the number of reported cases diagnosed
between 1983 and 2012.
Romania
Slovakia
Slovenia
Spain HIV reporting has existed since the 1980s in some of the 19 Autonomous Regions of Spain. For 2003–2011, data are available only for nine regions:
Asturias, Balearic Islands, Basque Country, Canary Islands, Catalonia, Ceuta, Extremadura, La Rioja and Navarre. Since 2004, data are available for
10 regions (+ Galicia). Since 2007, data are available for 11 regions (+Madrid). Since 2008, data are available for 14 regions (+ Aragón, Castilla-La
Mancha and Melilla). Since 2009, data are available for 17 regions (+ Cantabria, Castilla-León and Murcia). Since 2012, data are available for 18 regions
(+Valencia). Since 2013, data are available for all the 19 regions of Spain (+ Andalucía). Rates are based on the corresponding populations for each year.
It has not been possible to include data from several regions for AIDS reporting in 2014–2017, so rates for those years are based on the corresponding
population.
Sweden Due to changes in the HIV/AIDS surveillance system, AIDS reporting has not been mandatory since 2000. Since 2008, AIDS data are not reported from
Sweden because the national AIDS surveillance system had been discontinued.
United Kingdom The United Kingdom has moved toward surveillance of AIDS within three months of HIV diagnoses. As a result, the AIDS figures provided from 2015 are
likely to be lower than those previously reported.
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HIV/AIDS surveillance in Europe 2018 – 2017 data SURVEILLANCE REPORT
Country Comments
Non-EU/EEA
Albania
Andorra
Armenia
Azerbaijan
Belarus All data are presented by "date of statistics" (instead of "date of diagnosis").
Bosnia and
Herzegovina
Georgia Data for 2016 are presented by "date of statistics" (instead of "date of diagnosis").
Israel
Kazakhstan
Kyrgyzstan
Monaco
Montenegro
Republic of Moldova
Russian Federation
San Marino
Serbia Data on HIV tests refer to the number of people tested and do not include people tested in the reference laboratory or private laboratories.
Switzerland
Tajikistan
The former AIDS cases include only people diagnosed with AIDS at the time of HIV diagnosis.
Yugoslav Republic
of Macedonia
Turkey Reported HIV cases exclude people diagnosed with AIDS at the time of HIV diagnosis. Reported AIDS cases only include people diagnosed with AIDS at
the time of HIV diagnosis. Table 14 (see Tables section): CD4 cell count data exclude people diagnosed with AIDS at the time of HIV diagnosis. All data are
presented by "date of statistics" (instead of "date of diagnosis").
Turkmenistan
Ukraine All data are presented by “date of statistics” (instead of “date of diagnosis”). Data reported from Ukraine exclude data from Crimea and Sevastopol City
for 2014–2017 and parts of the non-government controlled areas for 2015–2017; corresponding population denominators were used to compute rates.
Table 7 (see Tables section): mother-to-child transmission cases for 2016–2017 are provisional and may be adjusted in the coming few years.
Uzbekistan
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SURVEILLANCE REPORT HIV/AIDS surveillance in Europe 2018 – 2017 data
Annex 6
New HIV diagnoses and rate per 100 000 population, adjusted for reporting delay and adjustment coefficients,a 2014–2017
Annex 7
HIV/AIDS surveillance in Europe: participating countries and national institutions
122
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